咨询问卷Intake questionnaire

邀请 Iris 来了解你的身体Invite Iris to get to know your body

六个部分，大约十分钟。答案会自动存在这个浏览器里，中途有事走开，回来接着填就行。没有标准答案，照实写就好，我不评判。Six parts, about ten minutes. Your answers save in this browser as you go, so if life interrupts, come back and carry on. There are no right answers. Write it as it is, I don’t judge.

亲爱的你，欢迎你邀请我来了解你的身体。减脂的过程也是你更了解自己的过程，我们通过一段时间的践行和观察，重新梳理自己和身体的关系、自己和食物的关系，最终找到属于你的管理方案。
—— IrisDear you, thank you for inviting me to get to know your body. Losing fat is also a way of getting to know yourself. Over a stretch of practice and observation, we’ll look again at how you relate to your body and to food, and in the end find the way of managing both that belongs to you.
Iris
开始之前Before we begin

先告诉我你是谁First, tell me who you are

填完这一步，我会把「继续填写」的链接发到你邮箱，中途走开也不会丢。我这边也知道你开始了，方便在微信上找到你。After this step I’ll email you a “continue” link, so nothing is lost if you step away. I’ll also know you’ve started, so I can find you on WeChat.

请填写称呼、邮箱和微信号Please fill in your name, email and WeChat ID
一 · 饮食与口味习惯Part 1 · Eating and taste habits

你平时是怎么吃的How you usually eat

1. 平时吃的东西，更接近哪一种？1. Which is closest to how you eat?
请选一项Please choose one
2. 每天大概吃多少绿叶蔬菜？用自己的拳头量，煮熟的蔬菜 1 个拳头大约 100 g2. How many leafy greens do you eat a day?Use your fist as the measure. One fist of cooked vegetables is about 100 g
请选一项Please choose one
3. 蔬菜你最常怎么做？3. How do you usually cook your vegetables?
请选一项Please choose one
4. 一袋中等包装零食，从打开到吃完通常需要多久？4. A medium bag of snacks: how long from opening it to finishing it?
请选一项Please choose one
5. 早餐后多久会再次想吃东西？5. How long after breakfast do you want to eat again?
请选一项Please choose one
6. 吃饭速度怎么样？6. How fast do you eat?
请选一项Please choose one
7. 吃饭会吃撑吗？7. Do you eat until you’re stuffed?
请选一项Please choose one
二 · 作息、运动与久坐情况Part 2 · Routine, movement and sitting

你的一天是怎么过的How your day goes

1. 每天看电视、刷手机大概多久？1. How long do you spend on TV or your phone each day?
请选一项Please choose one
2. 每天运动多久？2. How long do you exercise each day?
请选一项Please choose one
3. 一天里你愿意舒舒服服坐着的时间有多久？3. How many hours a day would you happily spend sitting?
请选一项Please choose one
三 · 体型、家族与减肥经历Part 3 · Body, family and past attempts

你和你的身体，一路走来You and your body, so far

1. 父母、兄弟姐妹里，偏胖的有几位？1. Among your parents and siblings, how many are on the heavy side?
请选一项Please choose one
2. 亲近的朋友里，偏胖的有几位？2. Among your close friends, how many are on the heavy side?
请选一项Please choose one
3. 8 岁以前，你是什么体型？3. Your body type before age 8?
请选一项Please choose one
四 · 心理、情绪与压力Part 4 · Mind, mood and stress

你心里的那部分What’s going on inside

1. 你在意自己的外表吗？1. How much do you care about your appearance?
请选一项Please choose one
2. 平时对健康上心吗？2. How much do you think about your health?
请选一项Please choose one
3. 你容易焦虑吗？3. Do you get anxious easily?
请选一项Please choose one
4. 下面这些，你经常有吗？可多选4. Do these happen to you often?Tick any that apply
五 · 健康、体质与身体症状Part 5 · Health, constitution and symptoms

身体想告诉你的What your body is telling you

下面这些如果有，勾一下：If any of these apply, tick them:
6–11. 下面这些，是或否就行6–11. Just yes or no
6. 是否经常手脚冰凉？6. Cold hands and feet often?
7. 指甲是否容易脆断？7. Nails that break easily?
8. 洗头的时候掉发明显吗？8. Do you lose a lot of hair when you wash it?
9. 是否容易长痘？9. Prone to breakouts?
10. 到了傍晚小腿会肿吗？10. Swollen calves in the evening?
11. 是否腿部莫名抽筋？11. Unexplained leg cramps?
六 · 身体数据和照片Part 6 · Your starting measurements

今天的身体，记一个起点Today’s body, a starting point

用软尺，站直、自然呼吸，尺子贴着皮肤但别勒。腰围量最细和最粗两处，腿和手臂左右各量一次。以后每 15 天量一次，比天天看秤有用。Use a soft tape. Stand straight, breathe normally, tape against the skin but not tight. Measure your waist at the narrowest and the widest point, and thighs, calves and arms on each side. We’ll measure again every 15 days. It tells you more than the scale does.

原始照片，怎么拍Starting photos: how to take them 1. 穿浅色的衣服，尽可能露出想减脂的地方～
2. 背景干净、减少杂物，全身拍摄～
3. 可以固定手机拍一段视频，身体转四个面各定住一下，之后在视频里截图就好 [爱心]
照片不在这里传。填完问卷，直接发我微信就好。 1. Wear light-coloured clothes and show the areas you want to work on as much as you can
2. Clean background, no clutter, full body in frame
3. Easiest: prop the phone up, record a short video, pause facing each of four directions, then take screenshots from the video [Heart]
Photos aren’t uploaded here. When you’ve finished, send them straight to me on WeChat.
Together

收到了，谢谢你的坦诚Received, thank you for being honest

我会认真看完，然后在微信上找你约一次通话。记得把原始照片发给我哈。I’ll read it all carefully, then find you on WeChat to set up a call. Remember to send me your starting photos.

Iris 亦姝 微信二维码 · WeChat QR code
微信 IrisyishuWeChat Irisyishu扫码添加，备注「评估」Scan to add, note “assessment”