Debbie's 1:1 Diet - New Enquiry Form

Welcome to The 1:1 Diet with Debbie

Thank you for your enquiry. It is not easy asking for help, so please be assured I am here to help and support you every step of the way.
I will never ask you for a fee, commit to a contract or purchase anything more than what you need for your diet.

I am passionate about helping you to achieve your goal weight, to maintain your loss and never have to do another diet.
I am a Multi Award winning Consultant and have helped hundreds of clients achieve their own successful weight loss and maintain their losses.

I will work very closely with you throughout your weight loss journey providing you with all the advice, support, motivation and encouragement for you to achieve your own success as well as throughout maintenance.

I have dieted since the age of 14 and have done most diets out there. After having been a size 20 for seventeen years I decided to try one last time to diet and lose the weight to become a healthier, happier and more confident person. Following this Plan I lost 4 stone and went down to a size 8. I have maintained this loss for over 5 years now and this has been life-changing for me.

This is why I am so pationate about helping as many people as possible to give you the same success.
This is my Before and After photos
We will work out a plan that suits you and your lifestyle to get you the best results and when it needs reviewing we will discuss it and change the Plan accordingly.
New Enquiry Form

Please could you complete and submit the following information. Thank you
A little bit about you

Please answer the questions so that I can best help you achieve your goals
Name*

First NameLast Name
Email*
example@example.com
Mobile Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postcode
Date of Birth*

DayMonthYear
Date
Please enter your Height*
Please enter your approximate Weight*
Your Occupation*
Please indicate your level of Activity*
Lifestyle and Medical

These answers help me to recommend the best plan for your journey
Do you have any of the following conditions?

Alcoholic/substance misuser within one year of recovery?Anti-obesity medicationSerious illness, trauma in the last 3 monthsSerious mental health episode; such as schizophrenia, delusional disorder, psychotic episode, bi-polar disorder (within the last 6 months)?Current active anorexia, bulimia, or currently undergoing treatment for any eating disorder?Heart failure/attack, arrhythmia, valve disease requiring treatment (within the las 3 months)?Psychotic/schizophrenic medication?Stroke or TIA (within last 3 months)?Are you on the GLP-1 Injection?
Do you take any prescribed medication at all? If so please give names and dosage
Do you have any ongoing medical conditions? If so, please give details
Do you have any allergies or intolerances? If so, please give details
Have you had any general accidents or any surgery in the last 3 months?
If yes above, please give details & dates of accident or operation?
Women only: have you given birth in the last 3 months?
Women only: are you currently breastfeeding?
Are you currently on the GLP-1 Injections?
NOTE: The 1:1 Diet by Cambridge Weight Plan is NOT appropriate for those who are alcoholic, substance misusers, underweight, pregnant, breastfeeding, or who have given birth in the last 3 months, and those younger than 14 years.
How much weight would you like to lose?
Have you tried this diet or a similar diet in the past ? (Please state which one)
Use this space to note anything else you think I should know or if you have any questions ahead of your appointment.
Space expands so type away!
Would you like to receive news and my latest offers?

YesNo
I consent to being contacted ?

YesNo
How did you find me? If you were referred to me please let me know who.
Please confirm the following and agree with the declaration:

1. The information given is correct and I have been advised to consult my GP before starting any weight loss programme.

2. I understand the importance of following selected Step according to directions given by my Consultant and additional literature supplied by CWP

3. If my health status/medication changes while using any CWP Step, I agree to notify my Consultant.

4. I understand that there is a legitimate interest in CWP and my Consultant holding the data on the Personal Record Form in conjunction with my use of the Programme. I understand it may be necessary for you to provide data to medical professionals and vice versa in relation to me starting the Programme and that this is a vital interest which forms the legitimate basis for processing.

5. I am aware that it is my responsibility as a client to have regular medical reviews with my GP to assess any medication adjustments.

6. I will be supplied with the relevant CWP Booklet and CWP privacy notice by my Consultant and I have read and understood these prior to completing this form.
I agree with the above declaration*

Yes
Should be Empty:

Welcome to The 1:1 Diet with Debbie

I will never ask you for a fee, commit to a contract or purchase anything more than what you need for your diet.

New Enquiry Form

A little bit about you

Lifestyle and Medical