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HUMAN NUTRITION UNIT VOLUNTEER FORM (CONFIDENTIAL)Please complete and return if you are interested in participating in the study
If you would prefer a printable form rather than online version please click here.
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Name
Address
email address
Tel no: Home
Tel no: Work
Date of Birth
Age
Occupation
Accurate weight (kg)
Height (cm)
Has your weight been stable during your adult years? - give details
Do you smoke?
How many a day?
If you've stopped, when did you stop?
What regular exercise do you do and how often is this?
Do you eat any particular diet? (e.g. vegetarian, gluten free weight loss inc: allergies)
Do you take any supplements? (e.g. vitamin tablets, fish oils).
What foods will you not eat?
Do you have any chronic illness? (e.g. diabetes, heart disease, thyroid disorder)
Detail any serious illness or operations
Detail any medication you take regularly (e.g. painkillers, oral contraceptives)
How long would you be able to stay in the Human Nutrition Unit?
Which study would you like to take part in?
Would you object to your name being put onto our volunteer database?
Please include any other information you may consider relevant
How did you hear about us?
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