Your intention to register means that you are seriously interested to change or improve your health situation. Completing this registration will cost you an average of 20 min. of your time. The accuracy with which you will do this is obviously very important to determine your personal profile on which your L2C-Health program will be based. The completeness of your filled in intake form determines how the program will work.

1 Create an account

2 Personal details


3 Your medical history

4 Tell us about your health

for 3 or more days

One or more times an hour

In the past 5 years

In the past 5 years

In the past 5 years

In the past 5 years

In the past 12 months

Whites of eyes

In the past 2 years

In the past 2 years

5 What medication are you using

6 Food / Habits / Allergies

After 10pm at night

Daily consumption

6-8 glasses a day

in past 2 years

no intake 2+ days

What is the emotional influence of food

Are there food restrictions for religious reasons (select any below)?

7 Tell us about your lifestyle

Amount of cigarettes a day

Used in the last 5 years

Amount of alcohol consumptions a week

Sudden weight loss or gain?

10kg weight change in the last year

Experienced severe trauma in the past two years

Tired in the mornings

hours / night

Is breastfeeding the only source of food for the baby?

Flights in the past 6 months?

Vaccinations in the past 6 months?

Describe the family structure

Describe any family member that has overweight


Thank you for filling in your information, we will soon contact you for advise, payment and, of course, your personal program. Next you should purchase one of our program packages!


Ariel University