Genderfm
Pregnantyesno
First Name *
Last Name *
Street/No. *
ZIP *
Phone *
EMail *
Date of Birth *
Height (cm) *
Occupationsittingstandingphysically demanding
I DO NOT HAVE ANY medical conditions, allergies, etc.
Cardiac InsufficiencyJoint PainKidney ComplaintsAsthmaThyroid HyperfunctionThyroid HypofunctionVertigo / DizzinessSkin disordersMigraineDiabetesHigh Blood PressureGluten intolerance / AllergyLactose intoleranceLong CovidOther, e.g. Sleep Disturbance, Depression, Digestive Issues:
I AM NOT CURRENTLY TAKING ANY medication, hormones, etc.
Blood lipidsUric acidDiabetesThyroidAntipsychoticsDiureticsOther, e.g. Contraceptive / Hormone replacement:
I eat EVERYTHING (no food allergies?)
(Select 4 max)
I RARELY eat: MeatPoultryFishCheese
I NEVER eat: MeatPoultryFishCheeseCow’s MilkNatural YoghurtGoat’s Milk/YoghurtSheep’s Milk/YoghurtSeafoodSoya ProductsPorkOther:
Weight (kg) *
Desired Weight (kg) *
Package
(How do our packages differ?)
ONLINE PREMIUM
ONLINE
STANDARD
Ideal
- Weight: > -15 kg - diff. diseases - Close support
- Metabolic Balance known - Coarse-meshed support
- On-site support - Group discount
Support
- 5 Zoom calls à 45 min. - 6 mos support via Zoom/E-Mail/Phone
- Kick-off call via Phone - 6 mos support via E-Mail
- 3 appointments on-site - 6 mos support via E-Mail/Phone
Price (CHF)
1'149.00 (Prepayment)
549.00 (Prepayment)
749.00 (Invoice)
ONLINE PREMIUMONLINESTANDARD
CHF 1'149.00 (Prepayment)
CHF 549.00 (Prepayment)
CHF 749.00 (Invoice)
CHF 674.00 (Invoice)
CHF 637.00 (Invoice)
Where? ZurichLucerneBenglen (Fällanden)
Single Person or Group? Single PersonGroup of 2Group of 3
First name, last name of 2nd group member
First name, last name of 2nd group member First name, last name of 3nd group member
Language nutrition planEnglishGermanFrenchItalian
Anything else you'd like to share?
I accept the GTC.
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