SAI NUTRITION CLUB

CUSTOMERS HEALTH CHECKUP PROFILE

CONSULTANT NAME: NARRAVULA .SANDEEP NAME: REFERENCE: AGE: DATA COLLECTED BY: DATE: TEL NO: GENDER: CELL NO: 9676446000, 9441434012 S.NO: ADDRESS:

- We care your health and wealth

DAILY DIET INFORMATION

COFFEE/TEA(?): LUNCH: VEG/NON-VEG(?): OTHERS: BREAKFAST: EVENING SNACKS: ALCOHOLIC(?): SMOKING(?): DINNER: WATER QUA:

MEASUREMENTS
HEIGHT WEIGH T BODY FAT % DATE ACTUAL IDEAL TARGET HEIGHT 5.0 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9 5.10 5.11 6.0 6.1 6.2 MEN 56-60 57-61 59-63 61-65 62-67 64-68 66-71 68-73 69-74 71-76 73-78 75-81 77-84 WOMEN 50-54 51-55 53-59 54-58 56-60 58-61 59-64 61-65 62-67 64-69 66-70 67-72 67-74 BODY METABO LIC AGE (BMA) BODY MASS INDEX(BMI) BODY METABOLIC RATE(BMR) VISCERAL FAT (VF) SUB CUTANEOUS FAT % MUSCLE MASS % WEST SIZE

NORMAL BODY FAT: M F VISCERAL FAT(VF) 10-20 20-30 2-8

HIGH 21-25 31-25 9-14

RISK 25+ 35+ 15+

BMI <18.5 18.5 TO 25 25 TO 30 30 +

CLASSFICATION Underweight Normal Obese 1 Obese 2

BMR: M~2000 F~1800 MUSCLE MASS: M~32-36 F~30-33

RECOMMANDED WATER CONSUMPTION: 1 LTR FOR 15KG OF BODY WEIGHT SUB CUTANEOUS FAT: 14 NOTE: COME WITH OUT HAVING BREAK FAST

ADDRESS: SAI NUTRITION CLUB, VELADHI KOTHAPALEM, NEAR BODDU RAI, CHANDARLAPADU(M), KRISHNA(DT).

LET FOOD BE THE MEDICINE & NOT MEDICINE THE FOOD, -Hippocrates, 400 bc.