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First name

Last name

Phone

Email

Your Weight*

Your Height

Your Age

Do you do any sports or physical activity?

Yes

No

How much water do you drink throughout the day?

Less than needed

I think I drink enough

Less than 1 liter

Do you have cravings for sweets? Salty foods?

I love sweets

I'm more into savoury

Not a fan of snacks

Do you experience swelling? Constipation?

I can tell you more at the consultation.

Yes, often

Yes, sometimes

No

What would you like to improve in your well-being

My energy overall

I want to lose weight

I need a better sleep

All of the above

Phone

Address

Ashgrove House, Kill Avenue, Dun Laoghaire, Dublin, A96 N9K0

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