Patient Details
Name
Shreya Kavali
Age
17
Sex
Female
Height in cm
169
Weight in Kg
103
Weight Lost in Past 6 Months
none
Marital Status
-
No of Children & Age
-
Address
h.no 95,BNR Hills, Jubilee Hills, Hyderabad
Contact Number
9705555542
How Did You Know About Us
Social media
MEDICAL HISTORY & MEDICATION
• Please provide details of any relevant medical history, such as high
cholesterol, diabetes, heart disease, ADHD, thyroid conditions (hypo/hyperthyroidism), recent
surgeries, gastrointestinal disorders, mental health issues (e.g., depression), eating disorders,
recent sports injuries, accidents, anaemia, etc. Attach any related reports if available.
Cholesterol levels are higher than normal
• Since when have you been aware of any disorders or deficiencies?
• Are there any medications you are currently using? If yes, please specify.
• Have you experienced any specific side effects from the medication you are
taking, such as increased hunger, gastritis, or other specific symptoms/issues?
-
• Do you experience frequent burping, bloating, flatulence (passing gas), or
indigestion? Please specify.
No
• Have you ever been diagnosed with an eating disorder? (Yes/No)
No
• Do you take any vitamin supplements? If yes, please list them below:
NERVUP OD
D3 (WEEKIY ONCE)
• Do you have any known intolerances to medicines or supplements?
NO
LIFESTYLE
• How many servings of tea or coffee do you consume per day?
• Do you smoke? If yes, how often? If no, do you have any past history of
smoking?
NO
• Do you consume alcohol? If yes, how frequently do you drink?
NO
• What time do you typically go to sleep?
11 PM
• At what time do you usually wake up?
IN BETWEEN 5:45 AM TO 6.30 AM
• On average, how many hours do you sleep per day?
6.5 HOURS TO 8 HOURS
• Are you currently experiencing stress? If yes, how do you manage it or how
did you manage it in the past?
STRESS YES, BINGE EATING ( STARTED IN 2021AND REDUCED IN THE MIDDLE OF 2024
• If yes, have you consulted with a therapist/counselor to manage your stress?
YES
• Have you ever been diagnosed with anxiety or depression?
NO
• If yes, how has your recovery been?
• Do you have a job? If yes, what is your position? Is it a sedentary job?
STUDENT - GRADE 12, MOSTLY SEDENTARY
GUT HEALTH
• Do you experience acid reflux? If so, how long have you had symptoms of
acidity?
NO
• In a typical week, how many times do you feel acidity (a burning sensation in
your stomach)?
NOT AT ALL
• Have you consulted a doctor to assess the severity?
NO
• Do you have any of the following symptoms?
• Do you experience discomfort in the upper esophagus or throat? If so, how
often does this occur in a week?
NO
• Do you experience heaviness after meals? If yes, how often does this occur in
a week?
YES, ONLY WHEN HAD A HEAVY MEAL, ONCE OR TWICE A WEEK
• Do you experience longer digestion times? If yes, how often does this happen
in a week?
YES, ONCE A WEEK
• Do you experience frequent burping? Does it typically happen after eating?
NO
• Have you experienced abdominal pain? If so, how frequently does it happen
each week?
YES, NOT FREQUENT FOR WEEKLY BASIS
• Do you experience sulphur burps (burps with a foul smell)? If yes, how often
do you have them in a week?
NO
• Do you experience regurgitation (the involuntary return of food or liquid from
the stomach)? If yes, how often does this occur in a week?
NO
• Does your acidity worsen before bedtime?
NO
• Do you experience constipation or diarrhoea? How is your bowel movement?
YES- CONTSIPATION SOMETIMES
• Please indicate your Bristol Stool Chart type:
TYPE 3
• Have you noticed any passage of blood or mucus in your stools?
NOT RECENTLY
• Do you experience pain when passing stools or urine?
NO
• Hormonal Health
• At what age did you experience your first menstrual period?
13 YEARS OLD
• Do you have regular menstrual periods? Yes/No
YES
• When was your most recent menstrual period? / How long did it last?
11/07/2024 - 5 DAYS
• Do you have any symptoms of pre-menopause or menopause discomfort?
NO
• Do you have PCOS or thyroid issues?
NO
• Have you been diagnosed with abnormal blood sugars or insulin resistance?
NO
• Do you have any signs of skin allergies or rashes?
NO
• Do you experience migraines, frequent headaches, runny nose, or itching
eyes?
HEADACHES , BUT NOT FRQUENT
Dietary Habits
• What is your dietary preference?
Non-vegetarian
VEGETARIAN
• Do you have any allergies to food? If yes, please specify.
NO
• Who cooks food for you?
MY GRANDMOTHER AND MOTHER SOMETIMES
• How often do you eat food from restaurants?
ONCE A WEEK OR TWICE
• Do you have cravings for sweets or any specific foods?
YES
• Are you willing to make changes to your diet?
YES
• How many liters of water do you consume daily?
2 AND HALF
• Have you tried any diet plans before? If yes, please provide details.
YES
GLUETEN FREE DIET FOR 2 WEEKS
• Have you encountered any side effects from the diet you followed?
NO
• Have you consulted with a dietitian or nutritionist before? If so, how did their
guidance help you?
YES I HAVE CONSULTED WITH A NUTRITIONIST , ONLY FOR 2 WEEKS, BUT THE 2
WEEKS HELPED ME
• Do you have any food intolerances?
I DONT EAT LADYSFINGER
Exercise
• Do you exercise? If yes, what type of workouts do you perform?
YES , CARDIO AND FLOOR EXERCISE
• What is the duration of your exercise sessions?
1 HOUR
• Are you guided by a fitness trainer?
YES N
• How would you describe your lifestyle?
SEDENTARY
NUTRITION LOG
• Please describe your meals and drinks from yesterday, with portion sizes and
the time if you can.
Time
Food/Drinks/Beverages Taken
Breakfast-
9 am
2 idly with podi
Brunch/Snack
Buttermilk - 1 glass
11:30 am
Lunch
12.45 pm
Jeera rice ( 1 and 1/2 cup) with raita
Tea Time
3.30pm
One slice of bread with peanut butter
Dinner
8pm
2 small roti with paneer fry
Bedtime snack/Dessert
None
