dietinsight

weight loss & nutrition clinic


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Whether you are remote, on a tight schedule, having a medical problem or just too lazy to visit our clinic, we can still help you!               
 
Please fill out our registration form below to get started. We will contact you shortly after receiving the form and discuss how we can use our expertise to make you feel healthier and happier. This will also help our dieticians understand your food habits, lifestyle and medical history, if any. This will help our dietician to plan your customized diet plans.
 
    

General Information
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Personal Information



Health History Questionnaire
All questions contained in this questionnaire are strictly confidential and will become part of your Clinic Record.







Do you take any medicines on daily basis? Please specify:






Food Intake: Please specify what you normally eat
Patient Contract
Your doctor is in charge of diagnosing, prescribing medications, and all other medical issues. The information obtained during your sessions(s) with our dietician, cannot replace or substitute for the services of your physician/doctor. The dietician shall not be responsible in any manner for any adverse effect occurred on following any diet as prescribed by the Dietician. I commit to strictly following this program for the period as directed without cheating. I commit to maintaining a daily food and exercise/activity diary. I commit to take responsibility for my own actions and know that the dietician cannot control what I consume.

 
 

 

 


         Dt. Lavleen Kaur dietinsight

         M.Sc. Foods & Nutrition, PGDFW # 3278 / Sec 21-D
         PGI, INSCOL (Ex-Intern) Chandigarh (U.T.)
         Life Member - Indian Dietetic Association India 0172-4569278
 
 
 
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