GFN Diet Center

GFN DIET CENTER

The GFN Diet Center has a team of qualified experts, which helps the members of GFN achieve fitness, with a number of health care services.

GFN Diet Center Offers:

  • Diet Consultation.
  • Diet plans, tailored specifically for the individuals, depending on his/her health conditions & goals.
  • Follow up and tracking the diet of the members.
  • Weight Management Programs.
  • Weight Management Tips.

GFN diet center is glad to make a difference in the lives and promoting a healthier community by helping its members in every possible way.

For the free consultation and Diet plan please contact your Fitness Center or contact the Weight Management Center on info@gfnnetwork.com or dietcenter@gfnnetwork.com

Nutritional Assessment

Membership Information

GFN Membership Number/ ID Number

Name*

Birth Date

Medical History

Check the following medical conditions you have been diagnosed with:
Heart diseaseHigh blood pressureAsthma/Respiratory problemsGI disordersCancerHeart attackHigh cholesterolSleep apneaGall bladder diseaseCardiovascular diseaseHigh triglyceridesDiabetesRenal diseaseStrokeMetabolic syndromeThyroid conditionLiver diseaseNot suffering from anythingOther

Injuries:

List from newest to oldest

Type of Injury:

Date Injured:

Therapy? (E.g physio):

List all medications:

List all known allergies:

Additional Comments

Physical Status

Height:

Current Weight:

Highest body weight

At Age

Lowest body weight

At Age

Body composition:

If you have had your body fat and muscle mass estimated by devices such as skinfold calipers, the Bod Pod, or bioimpedance analysis please provide the information below.

Lean Body Mass:

111

Body Fat:

222

Date measured:

Lifestyle/ Sports Information

In which sports do you participate (list sports and how often you do each sport):

List activity in each day of the week below.

Current training period:

TrainingCompetitionRecovery

Comments

Diet

Vitamin and mineral supplements:

Weight loss, herbal or sports supplements:

Food allergies:

Food dislikes:

Describe your daily eating habits:

Alcohol Frequency:

Alcohol Quantity:

Alcohol Type:

What do you eat and drink (list specific foods/drinks and quantities):
2-3 hours before workout?:

1 hour before workout?:

During a workout?:

After a workout?:

How often do you eat at restaurants or consume take-out or fast food?

How often do you eat snack foods? Type?

Describe your typical eating environment (e.g. alone, with a spouse or roommate, in car, at desk):

What is your primary goal for your nutrition counselling experience overall?

What 3 nutrition changes do you think should you make starting today?
1

2

3

Preferred strategy for nutrition intervention:

Day-to-day meal planFood choices (e.g. 2 starches, 3 protein) + selectionsGeneral guidelines (e.g. eat 6 vegetable servings/day)General guidelines (e.g. eat 6 vegetable servings/day)

Other Comments:

term and condition

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