Sensa zorg - zwangerschap

I am a *

Male

Female

Choose the skin colour that is closest to yours *

Originally I or my (grand-)parents are from *

I am *

<17 Years

18 - 30 Years

31 - 40 Years

41 - 50 Years

51+ Years

I eat less than three days a week: *

Multiple options allowed. Select what is applicable for you.

3 portions wheat, rice or pasta products per day

2 pieces of fruit per day

250 grams vegetables per day

3 portions milk products per day (milk, cheese, Yoghurt

50 grams oil or fat daily

1 portion of meat per day

1 portion of fish per day

1 egg per day

I live in *

the United states/Canada

the United Kingdom

The Netherlands

France

Belgium

Germany

Ik gebruik

Geen vitamines

Wel wel vitamines

alleen vitamines als de arts dit voorschrijft

Per day I eat: *

no sugar

between 1 and 6 teaspoons

more than 6 teaspoons

Select what is applicable for you *

I am overweight

I am underweight

My weight is good

I am 5 kilo heavier than my optimal weight. ( see chart for your optimal weight)

Ik sport 2 times or more per week

90% of my body is covered. Covering can be by clothes, hats etc.

My head is usually covered by e.g. a scarf, hat etc.

Do you have health problems or an allergy? *

My health problem or allergy is related to the following category:

	No	Yes
Hart & vessels
Bones & joints
Brain & Mind
Energy/fit
Skin

I am *

married and have children

married and don't have children

in a relationship and have children

in a relationship and don't have children

single

Sensa zorg - zwangerschap

For good advise we need to get to know you better.

I am a *

Choose the skin colour that is closest to yours *

Originally I or my (grand-)parents are from *

I am *

I eat less than three days a week: *

I live in *

Ik gebruik

Per day I eat: *

Select what is applicable for you *

Do you have health problems or an allergy? *

I am *