New Enquiry Form

New Enquiry Form

The 1:1 Diet with Liz
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
Phone Number

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Post Code
Date of Birth*

DayMonthYear
Date
Lifestyle and Medical

These answers help me to recommend the best plan for your journey
Have you done The 1:1 Diet before? *
If YES - use the box to tell me when you last did the plan, and the name of your previous Consultant
Please Enter your Height*
Please enter your approximate Weight *
Please enter your waist measurement
Your Occupation*
Please indicate your level of Activity
Do you have any ongoing medical conditions? If so, please give details*
Do you take any prescribed medication at all? If so please give names and dosage.
Have you had any general accidents or any surgery in the last 3 months?*
Do you have any allergies or intolerances? If so, please give details*
Women only: have you been pregnant or given birth in the last 3 months?*
Women only: are you currently breastfeeding?*
If you have selected YES to any of the above questions, please use this space to tell me about it. if YES to giving birth within 3 months, please give Babies date of birth State anything else you think I should know or if you have any questions ahead of your appointment. Feel free to call me on 07876506446 or email liz121diet@btinternet.com *
Gender at birth. (required to work out which Step and BMI) *
If you identify as a different gender, or use a different pronoun, please tell me below, so that I can advise accordingly
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.

Virtual / Remote weigh ins I can telephone / video call you on your weigh in day, you weigh at home and tell me the weight. If you are local enough, you can collect your products, if not, I will post them out.

Eckington

Scales are in the waiting room,take a seat for your comfort.
Your products will be made up in advance, ready for your appointment.

Sheffield

Please come into the shop and take a seat.
I work by appointments, and also happy to see anyone that just drops in.. please come in and take a seat until I’m free

Advanced bookings - your products will be made up in advance, ready for your appointment. For those dropping in, you can choose whichever products you'd like once you're here.

Most appointments are now Face to Face, just tell me if you'd prefer we keep our distance, I have enough room to do this.

All orders must be paid for before or on the day of your appointment, by cash, bank transfer or card payment. No credit will be given.
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A little bit about you

Lifestyle and Medical