Clinical nutritionist in Beckenham and online
Eat, lose weight, train WISELY!
Name *FirstLastEmail *Phone number (with country code)Gender *MaleFemaleDate of birth *Where do you live? (country, city) *What is your occupation? *Which option of a personalized diet would you like to order? *3 options for each meal5 options for each meal7 options for each mealHave you ordered a personalized diet before? *Yes, 3 options for each mealYes, 5 options for each mealYes, 7 options for each mealHeight (in cm) *Weight (in kg) *Waist and hips circumferences in cm *Or we can measure it on the consultation in person!What is your main problem you would like to solve? Or goal you would like to reach? *Your disorder storyDo you have any chronic diseases, if yes then what? *Did you have any operations, injuries, serious acute conditions? If yes then what? *Do you have any special conditions, such as pregnancy and breastfeeding ?WOMENDid you give a birth, and how many times if yes?WOMENWhat supplements do you take constantly? (name, dose) *Do you take any medicine constantly? If yes please write the name and dose *Do you have an allergy for any foods or supplements? *Do you smoke (constantly)? *How much water approximately do you drink a day? *How many times a day do you eat? *How many times a day would you prefer to eat? *33-444-555-6Write down here everything you ate yesterday or other usual day (time, what exactly, amount) *What is your meal style mainly? (I cook,my wife/husband/partner cook, I eat at the restaurants etc.) *What is very hard to refuse for you? (for example – sugar, sweets, sausage, beer and so on)Do you do any sports? If yes – what exacltly and how many times a week? *Describe your usual day plan (waking up time, work, going to bed time etc.)If there are any blood tests or other examinations you have , send them on WhatsApp, either bring for a consultation if it`s in personI willI have no anyWhat do you prefer for breakfast? (carbs part)OatsFlakesMuesliBreadCrispbreadBuckwheat PastaPotatoPancakesCasseroleFruits, berriesAdditionally from carbs I prefer for breakfast/ some particular foods:What do you prefer for breakfast? (protein part) *EggsCheese Cottage cheeseMilkYogurtProtein powder in shakeFishChicken and other poultryRed meat (pork/beef)Nuts, seedsSoya foodsTofuAdditionally from proteins I prefer for breakfast/ some particular foods:What do you prefer for second breakfast/snack? (If you chose 3 meals a day, no need to fill up this graph)FruitsBerriesNutsSeedsVegetablesSandwich (bread and cheese)Sandwich (bread and meat/poultry/fish)YogurtMilkCheeseUsually I don`t do this mealAdditionally I prefer for second breakfast/ some particular foods:What do you prefer for lunch? (carbs part) *RicePastaPotatoLentilsBeansBuckwheat BarleyMilletQuinoaSpeltOatsBreadFruits, berriesVegetablesAdditionally from carbs I prefer for lunch/ some particular foods:What do you prefer for lunch? (protein part) *Red meat (pork/beef etc.)Chicken and other poultryFishEggsSeafoodSoya foodsTofuMushroomsNuts, seedsAdditionally from proteins I prefer for lunch/ some particular foods:What do you prefer for afternoon snack/ potluck lunch? (If you chose 3 meals a day, no need to fill up this graph) *Sandwich (bread and cheese)Sandwich (bread and meat/poultry/fish)Muesli with milkMuesli with yogurtFruitsBerriesVegetablesCheeseMilkYogurtToast with peanut butter/ humusUsually I don`t do this mealAdditionally I prefer for afternoon snack/ some particular foods:What do you prefer for dinner? (protein part) *Chicken and other poultryFishEggsSeafoodSoyaTofuMushroomsCheeseCottage cheeseProtein powder in shakeAdditionally from proteins I prefer for dinner/ some particular foods:What do you prefer for dinner? (carbs part) *BreadCrispbreadBuckwheatPastaPotatoVegatablesAdditionally from carbs I prefer for dinner/ some particular foods:Which source did you hear about me from? *RecommendationGoogle searchGoogle advertisementInstagramFacebookOtherComment or MessageWebsiteSubmit