Please fill in the form below and I will contact you to arrange a Zoom Consultation Your Name Your Email (required) Subject Your Message Height (required) Weight (required) Date of Birth (this is required to calculate your BMI MaleFemaleOther are you pregnantYesNo Please consult with your GP before embarking on a diet/exercise programme Do you suffer from any allergies or Food Intolerances? YesNo Please tick items that you are allergic/intolerant to: FishNutsEggsDairyWheatOther Please state what you are allergic/intolerant to Do you suffer from any medical conditions YesNo Please consult with your GP before embarking on a diet/exercise plan Which of the following best describes your breakfast? I don't eat breakfastcereals/muesliPorridgeFry UpCereal BarOther Which of the following best describes your lunch? I don't have time for lunchchocolate bar/crispssandwichSoupCooked MealPub/cafe lunchstaff canteenEat at homeOther Which of the following best describes your evening meal? Home-cooked mealMeal fridge/freezerReady MealEat OutSnack Which best describes your typical daily diet I almost always eat 3 or fewer meals per dayI almost always eat at least 3 meals & several snacks a dayIt depends, sometimes less than three meals, sometimes more than 4 What is your main reason(s) for wanting to lose weight? Special Occasion coming upImprove physical appearanceEngage more with familyBecome healthierFeel Better day-to-day Which best describes your current priorities Focussing on losing weight for a special occasionLosing weight in generalLosing weight and putting a healthy eating plan in placeLosing weight and exercising regularly Employment Full TimePart TimeRetiredOther Exercise I exercise every dayI occasionally exerciseI would like to exercise more but lack motivationI never exercise Δ