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Weight Loss/Gain, Diabetes, Pregnancy Nutrition, Children Eating, GI Issues, Food Allergies, Metabolic Syndromes, Renal, and many others

Please enter the following basic information:
Name
E-mail
Gender Female Male
Age
Race
Preferred Units U.S. (ft, in, lb)
Metric (meter, cm, kg)
Height ft in
Weight lb
Waist Circumference in
Hip Circumference in

Please enter the following information if you have:
Body Fat Percentage %
eGFR
Triglyceride mg/dL
LDL mg/dL
Blood Pressure (Systolic/Diastolic)
/ mmHg
Fasting Sugar (2 different tests)
mg/dL; mg/dL
HbA1C (2 different tests)
;
Blood Glucose 2 hours after meals (2 different tests)
mg/dL; mg/dL

Please check Yes if you have diagnosed with any of the following:
Obese Yes No
Cancer Yes No
Type 1 Diabetes Yes No
Type 2 Diabetes Yes No
Gestational Diabetes Yes No
Other Diabetes Yes No
Pre-diabetes Yes No
Metabolic Syndrome Yes No
High Blood Pressure Yes No
Hyperlipidemia Yes No
Hypercholesterolemia Yes No
Chronic Kidney Disease Yes No
Disorders of Lipoprotein Metabolism Yes No
Hypothyroidism Yes No
Hypoglycemia Yes No
Polycystic Ovarian Syndrome Yes No
Anemia Yes No
GERD Yes No
Gastric/Peptic Ulcer Yes No
Alcoholic Gastritis Yes No
Lactose Deficiency Yes No
Lactose Intolerance Yes No
Gout Yes No
Food Allergies Yes No
Celiac Disease Yes No
Gastritis Yes No
Anorexia Nervosa Yes No
Bulimia Nervosa Yes No
Eating Disorder Yes No
Diaphragmatic Hernia Yes No
Crohn's Disease Yes No
Ulcerative Colitis Yes No
Diverticulosis Yes No
Irritable Bowel Syndrome Yes No
Constipation Yes No
Functional Diarrhea Yes No
Alcoholic Cirrhosis of Liver Yes No
Chronic pancreatitis Yes No
Osteoporosis Yes No
Sleep Apnea Yes No
Obstructive Sleep Apnea Yes No