Consultation questionnaire with Hugo Robin

Name *

Age

Sex *

Place of birth (Country and city) *

Where do you currently live? *

What do you do for a living currently? *

If life's circumstances were different/favorable, what would you be doing for a living (think about your dreams or passions)? *

Do you currently consume any type of pharmeceutical? (please describe briefly it's purpose and how long you been consuming it/them if it applies) *

Do you currently consume any type of nutritional supplement? (please describe which ones, brands, doses and how long you have been consuming them if applies) *

Please describe briefly why you are looking for a health appointment with me: *

Finally, being as honest as possible, (is for your own benefit after all), do you think is possible that your current "health situation/objective/goal" can be achieve or do you simply want to make it better and that is better than nothing? *

I declare that the above information provided is, to the best of my knowledge, the truth as I understand and remember it. Likewise, I declare that I have read in detail the information and requirements established by the holistic nutritionist Hugo Robin and his company Despertando Salud, which is clearly and punctually located on the article titled "Health Consultation With Hugo Robin" on the website “Tienda.DespertandoSalud. com”, the latter where I carry out the reservation and payment process for my consultation. Finally, I declare that I agree to the established guidelines and agreements. I am of legal age and have voluntarily signed this form. *

By "clicking" on this box you declare that you agree.

Date (at the time you fill this questionnaire) *