Personal Profile Form

Additional Information
* Name-Surname
*
* Your weight
*
Your Mobile Phone
*
* E-Mail Address
*
* Sex
*
* Date Of Birth
   
General Information
*How many days per week / meal package to get you thinking.?
*
* Weight your targeted:
*
General Information
* Do not give up food, what? (*)
*
* Is there any food you'll never eat, what to do?
*
*When was the last time you gave and how many lose weight?
*
* Normally, you tüketiyos few meals a day?
*
* Do you use alcohol?
*
* SDo you smoke? Yes No
CURRENT HEALTH STATUS (Please check the topics that you are seeing Treatment)
Hiper veya Hipo Tiroit Gastrointestinal Hastalıklar (üser, gastrit vs.) Hemodiyaliz
Böbrek Taşı / Kum Diyabet (tedavi uygulanmıyor) Hipertansiyon (tansiyon ilacı)
Kalp Hastalığı / Kalp Krizi Diyabet (hapla tedavi) Kardiyak Aritmi
Kalp Hastalığı (düretik tedavi) Diyabet (insülün tedavisi) Yüksek Kolesterol / Trigliserid
Anoreksia / Bulimia Son 3 ay içinde ameliyat geçirdim Kanser (radyasyon/kemoterapi tedavi)
Hamileyim Karaciğer Hastalığı Böbrek Hastalığı
Emziriyorum Depresyon Kronik Böbrek Yetmezliği

*A treat for your discomfort is not mentioned above G & ouml; you rmektemis? Enter the name of your illness, if any.
*
Information
* Make your sport?
*
* Your doctor may suggest a special diet for you?
*
* Do you have any food allergies? (peanuts, hazelnuts, strawberries, tomatoes, etc.)
*Do you have a food intolerance? (Yeast, gluten, lactose, etc ..)
* Are you Vegan and Vegetarian?
Powered by Bilgeweb