Intelligent Weight Loss at Home Quiz Intelligent Weight Loss at Home quiz All fields are mandatory. First name Last name Email Phone Adress Type of activity at work Office / field Date of birth month / day / year Weight Height Illnesses history Yes / No (write the illnesses) Do you have any allergies? NoYes What allergies? What was the maximum weight you reached? How long ago? How long did maintained this weight? What is your purpose? The goal you want to achieve? Do you consume dairy products? NoYes Do you eat fruits? NoYes Do you eat vegetables? NoYes Do you eat meat? NoYes Favorite foods: Foods and beverages that you would never consume: Other details: Restrictions on sports NoYes What restrictions? Have you undergone surgery or suffered accidents? NoYes What interventions? How to assess the level of physical effort of daily activities: Very lowLowModerateHard / Very demanding Are you training at this moment? NoYes How often and how long do the workouts last? Do you take nutritional supplements, vitamins, minerals? NoYes What nutritional supplements, vitamins, minerals? Front picture Back picture Right side picture Left side picture
