Survey | Scandinavian Nutrients

Your first name *

Your middle name

Your last name *

Your sex *

Male

Female

Prefer not to say

Your date of birth *

Your e-mail *

Your phone number *

Your weight, KG *

Your height, CM *

Your address: street, apartment, postal code, city, country *

Your lifestyle type *

Active

Moderately active

Passive (sedentary lifestyle)

If other, please specify:

Your blood type *

I (0)

II (A)

III (B)

IV (AB)

Unknown

Your Rhesus *

+

-

Unknown

Your national identification number (for FSMP) *

Do you use any pharmaceutical drugs at present? *

No

If YES, please write what pharmaceutical drugs you use:

Have you had any surgeries in your lifetime? *

No

If YES, please write what surgeries did you have:

Dialadoctor Global

Dialadoctor Global – questionnaire