{"content":[{"text":"Men’s Health History","bbox":{"left":0.705212,"top":0.113674,"width":0.21096800000000004,"height":0.01980499999999999}},{"text":"Please write or print clearly. All of your information will remain confidential between you and the Health Coach.","bbox":{"left":0.082353,"top":0.179991,"width":0.79583,"height":0.01727899999999999}},{"text":"PERSONAL INFORMATION","bbox":{"left":0.082353,"top":0.210881,"width":0.234858,"height":0.017734}},{"text":"First Name:","bbox":{"left":0.082353,"top":0.239537,"width":0.084584,"height":0.01727899999999999}},{"text":"Last Name:","bbox":{"left":0.082353,"top":0.270446,"width":0.08353700000000001,"height":0.01727899999999999}},{"text":"Email:","bbox":{"left":0.082353,"top":0.301203,"width":0.04529200000000001,"height":0.01727899999999999}},{"text":"How often do you check email?","bbox":{"left":0.532467,"top":0.301203,"width":0.226916,"height":0.01727899999999999}},{"text":"Phone: Home:","bbox":{"left":0.082353,"top":0.333817,"width":0.10455700000000002,"height":0.01727899999999999}},{"text":"Work:","bbox":{"left":0.400082,"top":0.333817,"width":0.042955999999999994,"height":0.01727899999999999}},{"text":"Mobile:","bbox":{"left":0.657369,"top":0.333817,"width":0.052563999999999944,"height":0.01727899999999999}},{"text":"Age:","bbox":{"left":0.082353,"top":0.364575,"width":0.033346,"height":0.01727899999999999}},{"text":"Height:","bbox":{"left":0.208856,"top":0.364575,"width":0.051606999999999986,"height":0.01727899999999999}},{"text":"Birthdate:","bbox":{"left":0.341258,"top":0.364575,"width":0.06981799999999999,"height":0.01727899999999999}},{"text":"Place of Birth:","bbox":{"left":0.569134,"top":0.364575,"width":0.10152099999999997,"height":0.01727899999999999}},{"text":"Current weight:","bbox":{"left":0.082353,"top":0.39715,"width":0.110552,"height":0.01727899999999999}},{"text":"Weight six months ago:","bbox":{"left":0.333807,"top":0.39715,"width":0.16954799999999998,"height":0.01727899999999999}},{"text":"One year ago:","bbox":{"left":0.66482,"top":0.39715,"width":0.10326200000000008,"height":0.01727899999999999}},{"text":"Would you like your weight to be different?","bbox":{"left":0.082353,"top":0.429726,"width":0.307426,"height":0.01727899999999999}},{"text":"If so, what?","bbox":{"left":0.576585,"top":0.429726,"width":0.08334199999999992,"height":0.01727899999999999}},{"text":"SOCIAL INFORMATION","bbox":{"left":0.082353,"top":0.475768,"width":0.20410699999999998,"height":0.017733999999999972}},{"text":"Relationship status:","bbox":{"left":0.082353,"top":0.504574,"width":0.142239,"height":0.017279000000000044}},{"text":"Where do you currently live?","bbox":{"left":0.082353,"top":0.535357,"width":0.20689799999999997,"height":0.017279000000000044}},{"text":"Children:","bbox":{"left":0.082353,"top":0.566115,"width":0.06527699999999999,"height":0.017279000000000044}},{"text":"Pets:","bbox":{"left":0.576585,"top":0.566115,"width":0.03705700000000001,"height":0.017279000000000044}},{"text":"Occupation:","bbox":{"left":0.082353,"top":0.597024,"width":0.08702,"height":0.017279000000000044}},{"text":"Hours of work per week:","bbox":{"left":0.657369,"top":0.597024,"width":0.176188,"height":0.017279000000000044}},{"text":"HEALTH INFORMATION","bbox":{"left":0.082353,"top":0.660793,"width":0.210511,"height":0.017734000000000028}},{"text":"Please list your main health concerns:","bbox":{"left":0.082353,"top":0.692479,"width":0.27487599999999995,"height":0.017279000000000044}},{"text":"Other concerns and/or goals?","bbox":{"left":0.082353,"top":0.779032,"width":0.21513300000000002,"height":0.017279000000000044}},{"text":"At what point in your life did you feel best?","bbox":{"left":0.082353,"top":0.865693,"width":0.30576000000000003,"height":0.017279000000000044}},{"text":"Any serious illnesses/hospitalizations/injuries?","bbox":{"left":0.082353,"top":0.898269,"width":0.333823,"height":0.017279000000000044}},{"text":"© 2007, 2013 Integrative Nutrition, Inc. | Reprinted with permission","bbox":{"left":0.075294,"top":0.953754,"width":0.480996,"height":0.017279000000000044}}],"images_bbox":[{"left":0.069444,"top":0.047285,"width":0.324591,"height":0.090909}],"images_bbox_not_text_overlap":[{"left":0.069444,"top":0.047285,"width":0.324591,"height":0.090909}]}