Health History
Gender
Pregnant or Breast Feeding
Pregnant or breast feeding
It is fine to do the Healthy Inspirations program if pregnant or are breast feeding. There are three simple rules:
1. Always follow your eating plan and eat enough to ensure you are not hungry.
2. Ask your Healthy Inspirations Health Coach about our caffeine-free protein powder (Proti Powder).
3. If you do not feel well, talk to your doctor.
Polycystic Ovary Syndrome (PCOS)?
PCOS
It is fine to do the Healthy Inspirations program if you have PCOS. There are two simple rules:
1. Always follow your eating plan and eat enough to ensure you are not hungry.
2. If you do not feel well, talk to your doctor.
Health conditions
Taking Medication?
1. If you take medications for type 1 or type 2 diabetes, or for hypertension (high blood pressure) please consult with your doctor before starting your eating plan.
A reduction in carbohydrate while taking certain medications may lead to a drop in blood pressure or blood sugar.
To avoid negative consequences your doctor may wish to advise you how to adjust your medication first. Feel free to show them your eating plan shopping list.
2. Always follow your eating plan, recording everything you eat and drink, and your body's responses. Eat enough to ensure you are not hungry.
3. If you do not feel well, immediately contact your doctor.
Low Blood Pressure
If you have low blood pressure you may have already experienced feeling faint or dizzy, and are aware of what movements trigger it.
If exercising in the centre, please ask the coach to advise you on exercises and movements to avoid, or to do carefully.
If exercising at home, or following exercise programs online, move into each new position slowly, especially when moving from a ground position to a standing position.
Gut
Gut
It's likely that there's nothing preventing you doing our healthy eating program if you have any gut condition. There are two simple rules:
1. Always follow your eating plan, recording everything you eat and drink, and how your body feels.
2. If you do not feel well, immediately contact your health coach or your doctor. Feel free to show them your eating plan shopping list.
Food Restrictions
Do you have any food intolerance, allergy or dietary restrictions?
Food Restrictions
Any other conditions?
Do you have ANY OTHER CONDITIONS that may require special consideration regarding diet and exercise?
Other conditions
Always discuss any physical difficulties, or injuries, (past, present or future) with your Health Coach. Provide details below.
Please Take a Minute To Read
This form helps you determine if you should seek medical advice before commencing any weight loss or exercise program. If you have any questions, please speak to your doctor.
No warranty of safety should result from the use of this online form. This screening system in no way guarantees against illness, injury or death. No responsibility or liability whatsoever can be accepted by Healthy Inspirations, its franchisees, employees, instructors and coaches for any loss, damage, illness or injury that may arise from any person acting on any statement or information contained in this Health History screening form.
The Healthy Inspirations team members are not doctors or allied health professionals. They are not trained to give you medical advice. They are trained to coach and support you through the healthy eating program and your weight loss journey.
Acknowledgement: I have read, understand and accept the advice above.
Something wrong?
If you do NOT accept the written acknowledgment please discuss this with your coach before proceding.
Thank You
If you answered YES to any question we encourage you to follow the advice regarding that question.
If you have any specific food restrictions you can discuss them with your coach.
We wish you every success on your weight loss and weight maintenance journey.