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Form to monitor weight changes over time

Write down when and where you weighed yourself. The scales you have used may be different, which could explain any weight variations. Weigh yourself without shoes and in similar clothes each time. Under remarks, fill in anything that might have caused changes in your eating habits and the amount of foods eaten, or might have caused weight loss.



Weigth (kg)

(diarrhoea, fever, food shortage, etc.)


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