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Leading you to better health YOUR HEALTH PROFILE 4 / 8 Medication Which medications or additives (e.g. nutritional supplements or vitamin preparations) are you currently taking? Name Dosage Since when? (month, year) Do you take any blood inhibitors, clotting agents or platelets? No Yes, please specify: Nutritional Profile Do you eat regularly? Yes No Are you currently following a special diet? If so, please give details: When do you eat your main meal? Describe your typical daily diet: Breakfast Lunch Dinner Between-meal snacks Drinking habits Nicotine, type: Alcohol, type: Coffee, type: Morning Midday Evening Number / day Glasses / day Cups / dayPDF Image | WaldHotel Health Profile
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