1:1 Diet New Enquiry Form
  • 1:1 Diet New Enquiry Form

    with Team Thomas
  • Contact Details

  • Format: 00000 000 000.
  • Personal Details

    These answers together with your medical information will help me to recommend the best plan for your journey
  •  - -
  • Medical Information

    If you are unsure of anything listed, please let me know in the notes section at the bottom
  • Extra Information

    Should you wish to start plan, you need to agree to the following Client Declatation during our first consultation:

    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 the 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 have been 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.


      Please see our privacy notice at the end of this form, together with an online version of our steps book. Hard copies of the Steps book avaiable upon request and also accessible in our app. 

      The app is free for all clients, to log in you'll need the address you've suplplied above together with a unique dieter code that I can provide once you've agreed to the above statements. 

      We can discuss this when we speak however,

      Looking forward to getting in touch,
      Vanessa & Martin :-) 
  • To view a copy of our online Steps Book, please click here.

     

  •  
  • Image field 60
  • We have a Fantastic New app, available on Apple & Android. 

    • Track your weight
    • Book Consultations 
    • View the Product catalogue 
    • Make order requests 
    • Features Helpful recipes when on Step 2 and above!
    • Read amazing Success Stories 

    Download on Apple: Click here

    Download on Android Play Store: Click here



    You will need the email address you signed up with and your dieter code which I will supply.



    Vanessa Thomas T/A 121 Team Thomas

    Vanessa 07904 589 565 one2onedietwithVanessa@gmail.com
    Martin 07512 857 115 121DietMrT@gmail.com
  • Should be Empty: