ONLINE BOOKING DIET/NUTRITION WITH DT. QILA

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Hi all! Thank you for approaching.

My name is Nurul 'Aqilah binti Hasan Ashaari and I am a dietitian with currently 3 years experience in practice.
I am a Registered Dietitian under Malaysian Allied Health Practitioners and ordinary member of Malaysian Dietitian's Association (MDA).
You may also find me through my LinkedIn Profile: https://www.linkedin.com/in/dietitian-aqilah/
Nama saya Nurul 'Aqilah binti Hasan Ashaari dan saya seorang dietitian dengan pengalaman selama 3 tahun.
Saya seorang Pakar Diet Berdaftar di bawah Pengamal Kesihatan Bersekutu Malaysia dan ahli Persatuan Pakar Diet Malaysia (MDA).
Anda juga boleh mencari saya melalui Profil LinkedIn saya: https://www.linkedin.com/in/dietitian-aqilah/

This google form is a booking platform and pre-assessment before online consultation. Feel free to ask me further through DM, Whatsapp or email me at nurulaqilahhasan98@gmail.com
Borang google ini adalah platform tempahan dan pra-penilaian sebelum perundingan dalam talian. Jangan ragu untuk bertanya lebih lanjut melalui DM, Whatsapp atau email saya di nurulaqilahhasan98@gmail.com

What you can expect from this session:
1. Understanding the general information about the nature of your condition and how specific diet can help with your current conditions (LONG TERM PRACTICE)
2. I do not provide FAST-TRACK SOLUTIONS. Please consult your doctor if you need medical interventions

1. Your Name/Nama anda *

2. Age/Umur *

3. Nutrition related concern/Masalah nutrisi yang dihadapi (T&C may apply/T&C tertakluk kepada keadaan) *

Type 2 Diabetes/Diabetes Jenis 2

Chronic Kidney Disease Stage 1-2/ Penyakit Buah Pinggang kronik Tahap 1-2

Chronic Kidney Disease Stage Stage 3a-5 (pre dialysis) / Penyakit Buah Pinggang kronik Tahap 3A-5 (Pra-dialisis)

PCOS / Masalah kesuburan wanita

Hypercholesterolemia/Dyslipidemia / Masalah kolesterol

Hypertension/ Tekanan darah tinggi

Sports Nutrition / Nutrisi sukan (T&C)

Weight Management/Pengurusan Berat Badan

Other:

Required

4. Weight/Berat (At least <3 months) *

5. Tinggi/Height (cm atau meter) *

6. Mode consultation / Mod rundingan *

One-off consultation / Satu sesi sahaja dan saya boleh memahami secara umum (RM80-RM120)

Coaching session (Daily for 1 month) / Bimbingan berkala (Harian selama 1bulan) (RM 480-RM 750)

Required

7. What do you wish to learn or what is your ultimate goal that I can help you with?/Apakah yang anda harap untuk dipelajari dari sesi ini atau matlamat utama yang hendak dicapai?

8. Preferred timing for first consultation? / Pilihan masa untuk rundingan kali pertama *

Weekends (1PM-3PM)

Weekends (9PM-10PM)

Weekdays (3pm-4pm)

Weekdays (9pm-10pm)

9. Contact number or email / Nombor atau emel untuk dihubungi (tujuan untuk memberi pautan link google meet) *

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