Specify how often you exercise per week
Each workout lasts on average
Specify how intense your workout is?
Specify whether and how you will exercise during the outlined diet?
Other remarks
Do you add extra sugar?*
Please specify how many teaspoons of sugar you consume on average throughout the day.
Are you able to completely stop adding sugar?
How many teaspoons are you able to give up?
How often do you consume alcohol?*
What type of alcohol do you prefer the most?*
How much water do you drink daily?*
Do you often eat out?*
Do you eat yellow cheese, processed cheese, or cream cheese?*
Do you eat products like sausages, hot dogs, pâté, or other similar deli meats?*
What type of bread do you eat most often?*
How often do you eat sea fish?*
Do you use a lot of salt?*
How many main meals do you consume per day?*
Do you often snack between meals?*
How often do you eat sweets?*
During a diet, can you completely give up sweets?*
Do you frequently drink sweet beverages, fruit juices, flavored waters, etc.?*
Create a list of consumed products for at least one selected day. When preparing the list, it is important to remember to record every consumed product, including all liquids (including water). Each entry for a particular day should include the following information:
The more precisely you specify the composition of the meal, the more accurate the analysis of your previous diet will be. It is very important to specify the size of the product or the number of grams. Each meal should be broken down into individual ingredients. Instead of "Roll with cheese," it is better to write "wheat roll" and "cheddar cheese" (see example below). It is also important not to "improve" the diet but to record everything truthfully.
Here is an example:
Meal time 8:00
Meal time 8:10
Meal time 9:00
Meal time 10:30-11:30
Meal time 13:00
Meal time 14:00
Meal time 18:00
Meal time 22:00
What is the main goal of the program?*
Do you have problems with cholesterol or triglycerides?*
Total Cholesterol?
LDL Cholesterol
HDL Cholesterol
Triglycerides
Sugar
Do you have high blood pressure?*
Do you have issues with constipation?*
Describe any other health problems?
List the food products you dislike or are intolerant to
Do you take any dietary supplements? If yes, please specify
If you have blood test results that you might want to send, please send them to the email address: ewelina.krutkiewicz@dobrydietetyk.pl
Specify the hours when you can eat Meals during the day. Breaks between them should not be longer than 4 hours, the first meal should not be eaten later than 2 hours after waking up, and the last 2-3 hours before going to bed. Also indicate which Meals you will eat at home and at what time you will eat lunch Meals.
Use the above example, which contains information:
In the above example, lunches will be eaten as follows:
Imię i nazwisko:
Adres email:
Telefon:
Plik:
Treść:
Przedstaw swoją sprawę zwięźle. Podaj dane takie jak: wzrost, wiek, waga ciała, preferowany termin wizyty. Skontaktuje się z Tobą najszybciej jak to możliwe w celu omówienia szczegółów.
Poradnia:
Wyrażam zgodę na przetwarzanie moich danych osobowych:
Wyrażam zgodę na przetwarzanie moich danych osobowych przez APZ.PL Sp. z o.o. NIP: 6220013166 KRS: 0000853208 zgodnie z ustawą z dn. 29 sierpnia 1997 r. o ochronie danych osobowych (Dz. U. z 2002 r. Nr 101, poz. 926 z późn. zm.) w celach administracyjnych, obejmujące przesyłanie informacji drogą elektroniczną przez serwis dobrydietetyk.pl.
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