Ideal Protein Health Profile

Dietary consultation involves a health profile whose purpose is not to establish a diagnosis, but rather to determine a clients health status in order to guide his or her weightloss plan. A client may be advised to seek medical advice based on his or her health profile.

General

Medical Information

Diabetes

Cardiovascular Function

Hypertension

Kidney Function

Liver Function

Colon Function

Stomach/Digestive Function

Ovarian/Breast Function

Thyroid Function

Emotional Evaluation

Inflammatory Conditions

General

Allergies

Eating Habits (please be as honest as possible so we may better help you)

Breakfast

Lunch

Dinner

Other

You must take vitamins and minerals while you are on the Ideal Protein Weight Loss Method. If you stop taking them you may experience undesirable side effects.

If you have health problems not indicated on this health profile, please consult your physician.

The signatory client hereby recognizes the veracity of the information provided herein and that he/she has made an informed decision to go on the Ideal Protein Weight Loss Method.

Contraindication Summary- Severe Kidney Disease, Severe Liver Disease, Congestive Heart Failure, Active Cancer or in remission less than 3 years, Cardiac/Cardiovascular Event within the last 6 months, History of Arrhythmia, Parkinson's Disease

Enter the verification code in the box below.