細(xì)心關(guān)懷表

1、細(xì)心關(guān)懷表客戶姓名________生日_______ID.NO.________________最佳聯(lián)絡(luò)時(shí)間______________________________________________電話(家)__________(辦)____________手機(jī)_____________FAX___________email___________________________________職稱(chēng)_________工作地址______

2、__________________________工作時(shí)間______________________________________________住宅地址________________________________________星座及血型_________________________________________________其它____________________________________________

3、得知產(chǎn)品來(lái)源_______________________________________________您減重(增重)最主要的動(dòng)機(jī)是什么:____________________________________________________________________________您想減或增幾公斤______公斤身高_(dá)________理想體重___________________________________________

4、_________________曾經(jīng)試過(guò)瘦身或增重法_______________________為何失敗□中途中斷□經(jīng)濟(jì)因素□缺乏信心□家人反對(duì)為何導(dǎo)致胖瘦□三餐不定□暴飲暴食□情緒困擾□喜甜食油炸物□食欲不佳□含糖飲料□其它其它健康問(wèn)題□體辦不足□失眠□頭暈頭痛□皮膚問(wèn)題□貧血□膽固醇□糖尿病□腹瀉□腸胃問(wèn)題□風(fēng)濕關(guān)節(jié)炎□過(guò)敏、氣喘□心臟病□血壓高低□肝問(wèn)題□腎問(wèn)題□慢性支氣管炎□經(jīng)痛□痔瘡□便秘□尿酸□其它___________

5、_________________________________________________________________目前服用藥物:□無(wú)□有________________________運(yùn)動(dòng)習(xí)慣:□無(wú)□有_______________________________________進(jìn)食時(shí)間早餐:□無(wú)□有時(shí)間:內(nèi)容:中餐:□無(wú)□有時(shí)間:內(nèi)容:晚餐:□無(wú)□有時(shí)間:內(nèi)容:最餓時(shí)間:最疲倦時(shí)間:起床:午覺(jué):就寢:上午點(diǎn)心:□無(wú)□有

6、時(shí)間:內(nèi)容:午后點(diǎn)心:□無(wú)□有時(shí)間:內(nèi)容:宵夜:□無(wú)□有時(shí)間:內(nèi)容:咖啡茶(杯):牛奶:糖(匙塊):喝水量天:cc吸煙:含酒飲料:手臂圍大腿圍小腿圍日期體重體脂肪上胸圍上腹圍下腹圍腰圍臀圍左右左右左右客戶反應(yīng)客戶體重管理表售后服務(wù)第二周日期日期用餐方法用餐方法評(píng)分評(píng)分備注()早:午:晚()早:午:晚()早:午:晚手臂圍大腿圍小腿圍體重體脂肪上胸圍上腹圍下腹圍腰圍臀圍左右左右左右客戶反應(yīng)量身量身日期日期()使用情況使用情況:_______

7、______________________________________________________:_____________________________________________________________________________________________________________________________________________________________________

8、________________________________________________________________________________________________________________________________________________售后服務(wù)第三周日期日期用餐方法用餐方法評(píng)分評(píng)分備注()早:午:晚()早:午:晚手臂圍大腿圍小腿圍體重體脂肪上胸圍上腹圍下腹圍腰圍臀圍左右左右左右客戶反應(yīng)

9、量身量身日期日期()使用情況使用情況:______________________________________________________________:__________________________________________________________________________________________________________________________________________