Name*
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Date of birth*
Age*
City, Country*
Height (cm)*
Weight (kg)*
Body Mass Index* <18g (Low Weight)<18,3-24g (Normal Weight)<25-29g (Hight Weight)<30-34g (Modere Obesity)<35g (Extreme Obesity)
Medical history
High Blood Pressure
Heart Disease
Arthritis
Breathing problems
Sleep Apnea
Psychiatric conditions
Fatigue
Diabetes Type 1Type 2Gestational
Blood disorders
Allergies
Medication
Smoke NeverRarelySometimesUsually
Alcohol NeverRarelySometimesUsually
Sugar intake NeverRarelySometimesUsually
Sports NeverRarelySometimesUsually
Surgical interventions
Other health problem
Subject*
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