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 pregnantYesNoPlease consult with your GP before embarking on a diet/exercise programme Do you suffer from any allergies or Food Intolerances? YesNoPlease tick items that you are allergic/intolerant to: FishNutsEggsDairyWheatOtherPlease state what you are allergic/intolerant to Do you suffer from any medical conditions YesNoPlease consult with your GP before embarking on a diet/exercise planWhich of the following best describes your breakfast? I don't eat breakfastcereals/muesliPorridgeFry UpCereal BarOtherWhich of the following best describes your lunch? I don't have time for lunchchocolate bar/crispssandwichSoupCooked MealPub/cafe lunchstaff canteenEat at homeOtherWhich of the following best describes your evening meal? Home-cooked mealMeal fridge/freezerReady MealEat OutSnackWhich best describes your typical daily diet I almost always eat 3 or less meals per dayI almost always eat at least 3 meals & several snacks a dayIt depends, sometimes less than three meals, someimes more than 4What is your main reason(s) for wanting to lose weight? Special Occassion coming upImprove physical appearanceEngage more with familyBecome healthierFeel Better day-to-dayWhich best describes your current priorities Focussing on losing weight for special occassionLosing weight in generalLosing weight and putting a healthy eating plan in placeLosing weight and exercising regularlyEmployment Full TimePart TimeRetiredOtherExercise I exercise every dayI occassionally exerciseI would like to exercise more but lack motivationI never exerciseShare this:TwitterFacebookPinterestLike this:Like Loading...