Jo Ostlere at The Life Balance Studio New Enquiry Form
A little bit about you
Please answer the questions so that I can best help you to achieve your goals
Name
First Name Last Name
Email
example@example.com
Phone Number
Area Code Phone Number
Address
Street Address
Street Address Line 2
City State / Province
Postal / Zip Code
Date of Birth
Day Month Year
Date
What's your why? This is not just about losing weight and feeling healthier, fitting smaller clothes - drill down and discover why you 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 Measurements - Bust/Chest, Waist at Tummy Button and Hips
Do you have any Allergies/Intolerances or Dietary requirements
Your Occupation
Please indicate your level of Activity
Do you take any prescribed medication at all? 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 if you are mobile and able to travel to me at The Life Balance Studio in Silverknowes (social distancing applies) - or if you are looking for a consultant who will come to your own home?
Space expands so type away!
Use this space to note anything else you think I should know or if you have any questions ahead of our chat ...
Space expands so type away!
Should be Empty:

Jo Ostlere at The Life Balance Studio New Enquiry Form

A little bit about you

Lifestyle and Medical