Once you submit this questionnaire with your payment, you will receive a confirmation email from me (check your spam or promotions if you do not see it in your inbox) with a link to book an appointment in my calendar.
See you soon!
Dr. Jacob Hans
So I can contact you on WhatsApp
Measure your waist at the belly button
Are you vegetarian?*
- No
- Yes
- Yes, but I eat fish and/or eggs
- No elements found. Consider changing the search query.
- List is empty.
Are you vegan?*
- No
- Yes
- No elements found. Consider changing the search query.
- List is empty.
Do you eat breakfast?*
- Yes
- No
- No elements found. Consider changing the search query.
- List is empty.
Fitness level*
- Couch Potato
- Weekend Warrior
- Exercise Regular
- Other
- No elements found. Consider changing the search query.
- List is empty.
What is your level of daily activity?
Daily Activity*
- Office work (most of the day sitting)
- Mostly standing
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- List is empty.
Have you had or do you currently have any medical problems, injuries, or surgeries?
*
- No
- Yes
- No elements found. Consider changing the search query.
- List is empty.
Are you currently on any medications?
*
- No
- Yes
- No elements found. Consider changing the search query.
- List is empty.
When do you feel that you need to snack during the day?
*
- Shortly after breakfast
- During most of the day
- In the evening when I return home from work
- At night before bed
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- List is empty.
$250
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