Información PersonalToda su información será guardada de manera confidencial entre usted y el Consultor de Salud.NombreField is required!Field is required!ApellidoField is required!Field is required!EdadField is required!Field is required!EstaturaField is required!Field is required!Fecha de NacimientoSelecione FechaField is required!Field is required!Lugar de Nacimiento Field is required!Field is required!Correo Electrónico Field is required!Field is required!Con que frecuencia revisa su correo electrónico?DiarioSemanalCasi nuncaField is required!Field is required!Telefono: Casa:Your PhonenumberField is required!Field is required!TrabajoField is required!Field is required!CelularField is required!Field is required!Peso Actual:Field is required!Field is required!Peso Hace 6 meses:Field is required!Field is required!Peso hace un año:Field is required!Field is required!¿Le gustaría que su peso fuera diferente?Field is required!Field is required!Si es así, ¿qué tanto?Field is required!Field is required!SocialEstado Civil:Field is required!Field is required!¿Dónde vive actualmente?Field is required!Field is required!¿Hijos?Field is required!Field is required!¿Mascotas?Field is required!Field is required!Profesión:Field is required!Field is required!Horas laborales por semana:Field is required!Field is required!SALUDPor favor, haga una lista de sus principales preocupaciones en materia de salud:Field is required!Field is required!¿Otras preocupaciones y/o metas?Field is required!Field is required!¿En qué etapa de su vida se ha sentido mejor?Field is required!Field is required!¿Ha tenido alguna enfermedad grave, hospitalización o lesión?Field is required!Field is required!¿Cómo es/fue la salud de su madre?Field is required!Field is required!Como es/fue la salud de su padre?Field is required!Field is required!¿Cuáles son sus antecedentes étnicos?Field is required!Field is required!¿Cuál es su grupo sanguíneo?Field is required!Field is required!¿Cómo duerme?Field is required!Field is required!¿Cuántas horas?Field is required!Field is required!¿Se despierta durante la noche?Field is required!Field is required!¿Por qué?Field is required!Field is required!¿Algún dolor, rigidez, hinchazón?Field is required!Field is required!¿Estreñimiento/diarrea/gases?Field is required!Field is required!¿Alergias o sensibilidad? Por favor explique:Field is required!Field is required!SALUD DE LA MUJER¿Es regular su menstruación? Field is required!Field is required!¿Cuántos días le dura?Field is required!Field is required!¿Con cuánta frecuencia?Field is required!Field is required!¿Tiene dolor o síntomas? Por favor explique:Field is required!Field is required!¿Tiene o está cerca de la menopausia? Por favor explique:Field is required!Field is required!Historia de control de natalidad:Field is required!Field is required!¿Le dan infecciones de hongos o de vía urinaria? Por favor explique:Field is required!Field is required!MEDICA¿Toma algún suplemento o medicamento? Por favor haga una lista:Field is required!Field is required!¿Qué papel juegan los deportes y el ejercicio en su vida?Field is required!Field is required!¿Algún curador, ayudante o terapia con el cual esté involucrado? Por favor, indíquelos:Field is required!Field is required!ALIMENTOS¿Su familia y/o sus amistades la apoyarían en su deseo de hacer cambios en su manera de comer y/o estilo de vida?Field is required!Field is required!¿Usted cocina? SINOField is required!Field is required!¿Qué porcentaje de su comida está hecha en casa?Field is required!Field is required!¿Dónde consigue el resto?Field is required!Field is required!¿Le dan antojos de azúcar, café, cigarros o tiene alguna adicción fuerte?Field is required!Field is required!¿Qué alimentos comía con frecuencia de niña?DesayunoField is required!Field is required!AlmuerzoField is required!Field is required!CenaField is required!Field is required!MeriendasField is required!Field is required!LíquidosField is required!Field is required!¿Qué tipo de alimentos come hoy en día?DesayunoField is required!Field is required!AlmuerzoField is required!Field is required!CenaField is required!Field is required!MeriendasField is required!Field is required!LíquidosField is required!Field is required!COMENTARIOS ADICIONALES¿Hay algo más que quisiera compartir?Field is required!Field is required!Submit
