New Enquiry Form for The 1:1 Diet with Faith

A little bit about you

Please answer all the questions so I can learn more about you, your medical history and your goals. For returning clients, this will enable me to update your medical form. Everything is held confidentially and will help us to plan which Step is appropriate for you to start on and your weight loss journey.
The 1:1 Diet - Results with Faith

New Enquiry Form
Name*

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

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

DayMonthYear
Date
What's your why? This is not just about losing weight and feeling healthier or wearing smaller clothes - drill down and discover why you really want to lose some weight and share this me ...
Lifestyle and Medical

These answers help me to recommend the best plan for your journey
Please enter your Height*
Please enter your approximate Weight*
Please enter your approximate Waist Measurements in inches*
Do you have any Allergies/Intolerances or Dietary requirements*
Your Occupation
Please indicate your level of Activity
Do you take any prescribed medication? If so, please give names, dosage and start date*
Do you have any ongoing medical conditions? If so, please give full details*
Have you had any general accidents or any surgery in the last 3 months?*
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, and those younger than 14 years.
Please let me know how you would like to work with me:- either face to face or a Virtual Consultant where all our meetings are carried out on Whatsapp, Facetime or Zoom and your products are delivered to you?
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Use this space to note anything else you think I should know or if you have any questions ahead of our chat ... I'll be in touch with you shortly x
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Would you be interested in talking about training to be a 1:1 Diet Consultant so you can access products at wholesale prices and start to build a network of slimmers who you can support and earn an additional income from?
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A little bit about you

The 1:1 Diet - Results with Faith

Lifestyle and Medical