Consultation Questionnaire

Please complete to continue your appointment.

General Info

Recent blood tests

Health

Measurments

*The correct methods for measuring are as follows:

CHEST = Place one end of the tape measure at the fullest part of your bust, wrap it around (under your armpits, around your shoulder blades, and back to the front) to get the measurement.

WAIST = Use the tape to circle your waist at your natural waistline, which is located above your belly button and below your rib cage.

HIPS = Start at one hip and wrap the tape measure around your bum, around the other hip, and back to where you started. Make sure the tape is over the largest part of your buttocks. Do it in front of a mirror to make sure the tape is level at the back.



Exercise

Usual diet

Food frequency

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