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Platinum Package Weight Management
Platinum Package Weight

The form for consultation covers many areas; however there are only very few questions that are mandatory

Name *
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Age *
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Gender *
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Email *
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Contact No
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Country
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Occupation
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Work Tiimings
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Sleep Hours - Total
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Height *
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Weight *
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Physical Activity
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Smoking
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Alcohol consumption
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Your goal for weight management
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Existing medical condition please specify YES/NO and recent values

Diabetes Mellitus
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Hypertension
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Ischemic Heart Disease(Heart attack)
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Blood Cholesterol & Triglycerides
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Thyroid Disorder
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Acidity
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Constipation
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Other health problems
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Major illness in past
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History of surgical operation
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If Yes Description of surgery
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Dietary information
Eating habits
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Specific likes
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Specific Dislikes
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Eating Habits
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Snacking Habits *
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Number of Tea / coffee per day
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Hunger Peat time
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Main Meal
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Eating Habits
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No. of Meals/ Day
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Quantity of Oil
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Kind of Oil
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Water Consumption / Day
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Previous Diet Programs
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Exercise Habits
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Female
Menstrual Pattern
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Upload Your Latest Report
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