One Week Kickstart Plan

Full Name*

First NameLast Name

Date Of Birth*

Address*

Street Address

Street Address Line 2

TownCounty

PostcodeCountry

Sex*

Contact Number*

Area CodePhone Number

Email*

example@example.com

Height*

In Feet and Inches

Weight*

In Stones and Pounds

Goal Weight

In Stones and Pounds

YesNo

OPTION ONE: One Week Kickstart Plan: 7 Breakfasts, 7 Lunches, 7 Dinners, 7 Bars plus FREE tub of Water Flavouring (any flavour) AND FREE DELIVERY €100. Payment Link: https://revolut.me/r/7KLqiTgncgOPTION TWO: One Week Kickstart Plan: 7 Breakfasts, 7 Lunches, 7 Dinners, 7 Bars, 5 Packs of Pop Squares (any flavour) plus FREE tub of Water Flavouring (any flavour) AND FREE DELIVERY €110. Payment Link: https://revolut.me/r/4PpwZQoP6z

OPTION ONE: One Week Summer Shred: 7 Breakfasts, 7 Lunches, 7 Dinners, 7 Snacks plus FREE tub of water flavouring €100OPTION TWO: One Week Summer Shred: 7 Breakfasts, 7 Lunches, 7 Dinners plus FREE tub of water flavouring €80

YesSomewhatNo

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Please Note: The 1:1 Diet by Cambridge Weight Plan is NOT appropriate for those who are pregnant, breastfeeding (where it is the sole source of nutrition), have given birth/had a major trauma/had surgery within the last 3 months, current active eating disorder, serious mental health episode within the last 6 months, on MAOI medication, alcohol or substance misusers within one year of recovery, heart failure/attack / arrhythmia/valve disease / stroke/TIA within the last 3 months, those younger than 14 years of age, those with a BMI of 70+*

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If you would like to book in for a free consultation to find out more about how the 1:1 Diet plan works, you are welcome to make an appointment at any stage before, during or after you complete the 7 Day Kickstart Plan.

Bookings can be made via the 1:1 Diet App or visit my booking link here: https://www.fresha.com/book-now/1-1-diet-ireland-with-rebecca-jpmdqmqv/services?lid=1232057&eid=2871316&pId=1169169

Please note: If you wish to continue on-plan after the 7 Day Kickstart, you are required to book in for a consultation to tailor the plan to your specific requirements. Consultations take approx. 45 minutes and take place over the phone or via WhatsApp messaging.

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Referral Name (if you were referred to me by someone):

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