Initial health consultation with Intelligent Eating

APPLY FOR YOUR PERSONAL DISCOVERY SESSION

A complimentary initial conversation with Adam
to discuss improving your health will enable you to:

Understand the reasons why you have confusion on what to eat.

Find out why diets do not work.

Have clarity on how to achieve your health goals, where possible.

It is a 45-minute conversation, over the telephone or Skype.

To apply, simply;

1. Complete and submit the form below (as honestly as possible).
2. Schedule a time that suits you for a conversation.

Please note, Intelligent Eating is not for everyone. If it’s deemed that Intelligent Eating isn’t for you, there may well be resources we can refer you to. This form is confidential in accordance with 4, 4.1, 4.2, 4.3, 4.4, and 4.5 of our Terms & Conditions.

Discovery form

First & Last Name *

Your date of birth *

Address *

Email Address *

Telephone (home)

Telephone (mobile) *

Skype name & time zone *

List all prescription medications, over-the-counter drugs, or vitamin/mineral supplements you are taking *

List all allergies to medicines, and the reaction you had *

List any food allergies *

Please tick any boxes where recent changes have occurred. *

If 'other' please specify?

If 'other' please specify? *

What is your current weight (in any units, but please state which)

What is your height (in any units, but please state which)

What is your resting pulse? (please ask if you require help to measure this)

What is your most recent HbA1c? e.g. 40 mmol/mol

What is your total cholesterol in mmol/l? e.g. 4.6 mmol/l (if known)

If you know your LDL, HDL cholesterol and blood triglycerides, please write them below. e.g. LDL 1.7 mmol/l, HDL 1.1 mmol/l, Triglycerides 1.8 mmol/l

With respect to exercise tolerance and ability, how would you describe yourself currently?

Very little tolerance

Able to tolerate short bursts of exercise

Able to tolerate significant exercise

Able to run half a mile

Able to run a mile

Able to run a marathon

Please write your health goals below. Be as specific as possible, and please feel free to be open - this will be discussed sensibly and with respect. *

What do you find your biggest challenges to achieving your health goals to be?

What's your number one health goal right now? *

What are you doing at the moment to achieve your health goal? *

Why do you think Adam could be the right person to help you? *

Anything else you'd like to add.

APPLY FOR YOUR PERSONAL DISCOVERY SESSION

A complimentary initial conversation with Adam
to discuss improving your health will enable you to:

Understand the reasons why you have confusion on what to eat.

Find out why diets do not work.

Have clarity on how to achieve your health goals, where possible.

It is a 45-minute conversation, over the telephone or Skype.

To apply, simply;

1. Complete and submit the form below (as honestly as possible).
2. Schedule a time that suits you for a conversation.

If you have not already done so, please book a time for our initial discovery conversation using the online calendar:

COME VISIT US

FACEBOOK

Sign up NOW to the Intelligent Eating Newsletter

Well done! Let's talk!

APPLY FOR YOUR PERSONAL DISCOVERY SESSION

A complimentary initial conversation with Adam to discuss improving your health will enable you to:

Understand the reasons why you have confusion on what to eat.

Find out why diets do not work.

Have clarity on how to achieve your health goals, where possible.

It is a 45-minute conversation, over the telephone or Skype.

To apply, simply;

1. Complete and submit the form below (as honestly as possible). 2. Schedule a time that suits you for a conversation.

If you have not already done so, please book a time for our initial discovery conversation using the online calendar:

COME VISIT US

FACEBOOK

Sign up NOW to the Intelligent Eating Newsletter

Well done! Let's talk!

A complimentary initial conversation with Adam
to discuss improving your health will enable you to:

1. Complete and submit the form below (as honestly as possible).
2. Schedule a time that suits you for a conversation.