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Online Kidney Diet Consult
Form for online kidney diet consultation
1
Personal Information
2
Diet Information
3
Upload Prescription
Personal Information
First Name*
Last Name*
Phone *
Email *
Age*
Date Of Birth*
Gender
Male
Female
Next
Diet Information
Consultation
First consultation
Follow up consultation
Height* (in cm)
Weight* (in kg)
Systolic BP
Diastolic BP
Swelling
Swelling on feet
Mild
Moderate
Severe
No swelling
Current Health Problem :
Acute kidney disease
Chronic Kidney disease
Diabetes
High blood pressure
Cardiac disease
Other
Please Mention Other Health Problem:
Activity level: :
Bedridden
Sedentary lifestyle (minimal activities during the entire day)
Moderately active lifestyle (involved in activities like cooking/ walking/ playing, etc)
Very active lifestyle (involved in regular exercise like brisk walks/ dance/ jogging/ gymming/ athletics sports)
Appetite :
Good (satisfied with the amount of food eaten)
Fair (does not feel hungry and feels like eating less than usual)
Poor (eats little, may be due to nausea or loss of interest in eating or other reasons)
Next
Upload Prescription
Upload blood reports (reports should include renal profile):
* Please upload recent blood reports, preferably of the same month.
* You will need to upload the renal profile which should include serum blood urea nitrogen, serum creatinine, serum sodium, serum potassium, serum albumin, serum uric acid.
* You may upload reports of diabetes profile, thyroid profile, iron study, lipid profile and liver profile, preferably of the same month.
Upload Nephrologist’s prescription:
* Kindly upload the prescription paper of your Consultant doctor.
Diet preferences
Jain
Vegan (no animal food including milk and milk products)
Vegetarian (no eggs, fish, meat, sea foods, etc)
Non-vegetarian
Benefits of Kidney Patient Diet Plan
Kidney Disease Prevention
Kidney Disease Prevention
Following a prescribed diet properly helps prevent the kidney disease from progressing to more severe form.
Better quality of life
Better quality of life
The symptoms associated with the disease can be controlled by eating a healthy diet thereby improving the quality for life.
Meet the requirements
Meet the requirements
The demands of the body are increased while the kidney function is jeopardised. As a result providing energy and other nutrients in greater amounts is crucial.
Improved results
Improved results
Medications, dialysis and other treatments show better results when body is well nourished and healthy.
Boost immune function
Boost immune function
To prevent onset of infections and maintain body’s defence system
Maintain electrolyte balance
Maintain electrolyte balance
By managing foods you eat and fluid intake, electrolyte imbalances can be corrected.
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