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HRA - Datasprings
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HRA Assessment Form
First Name:
Email Address:
Date of Birth:
Select Date
Gender:
Male
Female
Weight in pounds:
Height in inches:
Pick the category that best describes how often you eat the following foods:
Vegetables:
Never, rarely
Occasionally, every other day
1 serving daily
2-3 servings or more daily
VegetableScore:
Your vegetable score is: