Ana Sáez Jiménez

CLINICAL-NUTRIOLOGICAL HISTORY
Date:
PERSONAL DATA:
• Name: Andriana
• Sex: Female
• Age: 31
• Marital status: Single
• Date of birth: 04/03/1991
• Occupation: Full time employee
• Telephone: 662582075
• Height: 1.64
• Starting weight: 56
• Country of origin: Greece
• Mail: Gioupiandria@gmail.com
PERSONAL, FAMILY AND SOCIAL HISTORY:
• Current disease problems No
• Diarrhea: YES/NO Depends on the food
• Constipation: YES/NO
• Nausea: YES/NO
• Burning or reflux: YES/NO
• Vomiting: YES/NO
• You have a diagnosed disease: NO/YES
• Have had a major illness: NO/YES
• You take any medication: YES/NO
• Which one:I’ve been doing homeopathy for a
FAMILY HISTORY year
Obesity: YES/NO Diabetes: YES/NO Cancer: YES/NO Hypertension: YES/NO
Current pregnancy: YES/NO
LIFESTYLE
Activity: Very Light Moderate Heavy
- How many days sport: 5 days per week
Consumption of (frequency and quantity):
•Alcohol: I don’t drink alcohol
•Tobacco: I don’t smoke
•Coffee: with milk? Which one?
I don’t drink any coffee
Sometimes I use almond milk 0 sugar
LIFESTYLE
Where do you work?
I work from home as well as outside
 Ana Sáez Jiménez

Timetable:
CURRENT DISEASE
• Do you have any type of disease? YES/NO
• Which one?
• Allergies?No
DIETARY INDICATORS
• How many meals do you eat a day? 3-4 depends on the
• Where do you eat? At home work
• Who do you eat with? I eat by myself
• What time do you usually eat?
- Breakfast Before 08:00
- Lunch 14:00-15:30
- Snack Every time I have time
- Dinner 22:00-22:30
• Do you usually snack between meals? YES/NO What? Fruit,nuts
• Do you prepare the food? YES/NO Who? Not always sometimes I order prepared protein
• Do you usually go shopping? YES/NO Who? By myself meals
• Time of day when you have the most appetite: Always hungry
• Water: quantity?Not much! It makes my tummy really bloated
EMOTIONAL
- Best weight you've ever felt at:I feel good with my weight
- What is your ideal body? Who would you like to look like? Bigger legs calves butt
- Which parts of your body do you like the least? And more? My tummy is always bloated
Maybe 60kg - What weight would you like to achieve? I don’t have a favourite part
- From 1 to 10 how you value your body: 6.5-7
Meals:
- Foods you don't like at all: Almost eat everything
- Foods that feel bad/allergies: No
What is your day like?
- Total sleep hours: 7-8
- Stress: YES/NO
- Anxiety: YES/NO
- Number of steps per day: I don’t know