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Dra. Jackie

ZÄNA Metabolic

Club ZÄNA

Consultations

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Comprehensive metabolic assessment consultation

Clinical form

To make the most of your consultation time.

Answer what you know: any fields you leave blank we go through during the consultation. Dra. Jackie reads this form and your lab results before your appointment.

01

It only takes a few minutes

Twelve short blocks. You can leave blank anything you do not know or that does not apply to you.

02

Attach your lab results

You can upload a PDF or a photo in block 09, at least 48 hours before your appointment.

03

No recent tests?

It is not a requirement for booking: in the consultation we will determine which ones are most appropriate for you.

    01General details

    02Body measurements

    In kilograms

    In centimetres

    In centimetres

    03Reason for the consultation

    What do you want to achieve? You can tick several options.

    04Medical diagnoses

    Tick everything that applies.

    05Family history

    In parents, siblings or grandparents.

    06Personal cardiovascular history

    07Surgery, medication and allergies

    Which ones and when?

    Name, dose and schedule

    08Current symptoms

    Tick everything you have right now.

    09Laboratory tests

    The more recent your tests are, the more precise the metabolic assessment will be. Upload them at least 48 hours before your appointment.

    PDF, JPG or PNG · up to 10 MB · one file

    10Women

    If it does not apply to you, leave the options unchecked.

    Are you pregnant?

    Are you breastfeeding?

    Are you going through menopause?

    Optional

    11Lifestyle

    Do you exercise?

    Do you drink alcohol?

    Do you smoke?

    Do you practise intermittent fasting?

    Have you followed a ketogenic diet before?

    12To finish

    Without this authorisation the submit button stays disabled.

    Fields marked with * are required. You can leave the rest blank: we go through them during the consultation.

    Important information. A medical consultation does not replace the care of your treating doctor. Under no circumstances is it recommended to stop taking medication without the supervision of the professional who prescribed it.

    See you at the consultation, mi gente ZÄNA!

    Still have questions? See what the consultation includes, how long it lasts and what you will get at the end.

    See the consultation