General information Name Surname GenderMaleFemale Email Send Email Date of birthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember12345678910111213141516171819202122232425262728293031 Caucasian Yes No Phone number +39 +31 Sensor device ID Weight Height
Physical activity Do you perform regular physical activity? Yes No How many times per week?1-2 per week3-4 per week7 per week Activity duration< 30 min30 - 60 min> 60 min
Nutrition Do you follow a particular diet?NoVegetarianVeganOther Do you regularly eat fruit and vegetable? Yes No Do you drink alcohol? Yes No Do you have a history of alcohol abuse? Yes No Have you recently lost weight without trying? Yes No Unsure How much weight have you lost?Not selected0.9-5.5 kg6.3 - 10.4 kg10.8 -14.9 kg15.4 kg or moreUnsure Have you been eating poorly because of a decreased appetite? Yes No
Past relevant information Diabetes Yes No Hypertension Yes No Collagen vascular Yes No IBD Yes No Previous intestinal surgery Yes No