New Enquiry - 1:1 Diet with Beth

With Bethan Gough

Thank you for your enquiry, please fill in the information below to enable me to set you up on the database and advise the correct starting step.
Personal Information

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

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Address

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Lifestyle and Medical

These answers help me to recommend the best step for your weight loss journey.
Please Enter your height:
Please enter your approximate weight:
Please enter your target weight:
Your Occupation:
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Do you take any prescribed medication at all? If so please give names and dosage:
Do you have any medical conditions? If so, please give details:
Name and Address of GP Surgery:
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Do you have any allergies or intolerances? If so, please give details:
Have you had any surgery in the last 3 months?
If yes, please provide further details below including the date of the surgery:
Women only: have you given birth in the last 3 months?
Women only: Are you currently breastfeeding?
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. The minimum age to start plan is 14 years of age.
Use this space to note anything else you think I should know.
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With Bethan Gough

Personal Information

Lifestyle and Medical