Before your consultation | Sustainable Sehat

This form is for me to understand the background and build an understanding of the issue before we have a call or discuss further.

Answer what you can, and leave what you are unsure of. Fields marked * are needed.

If your child has trouble breathing, swelling of the lips or tongue, or goes floppy or pale after eating, call the emergency line wherever you are.

1. You and your child

Your name *

Please answer this one.

Email *

Please add an email I can reach you on.

WhatsApp number

Your child's first name *

Please answer this one.

Date of birth *

Please answer this one.

Your child is a

Girl Boy

2. The allergy

Who diagnosed the milk allergy? *

Please answer this one.

How old was your child when it was diagnosed?

How quickly do the reactions start?

Within minutes, up to about 2 hours Hours or days later Both Not sure

Which tests has your child had?

Any other allergies, or foods your child avoids for medical reasons? For example egg, soya, nuts, wheat. Add anything else about the reactions here too.

Where are things with milk now? *

Avoids all milk and dairy Has milk baked into things like cake or biscuits, nothing else Has some dairy (tell me which below) Not sure

Please answer this one.

Have you tried the milk ladder, reintroducing milk step by step?

Yes No Not sure what that is Have discussed with the doctor but not sure how to do it

If yes, which step did you get to, and how did it go?

3. Milk and supplements

What is your child's main milk or drink now? *

Breast milk Hypoallergenic formula (extensively hydrolysed) Amino acid formula Soya formula Soya drink Oat drink Pea drink Another plant drink No milk or milk alternative

Please answer this one.

About how much a day? If any.

Any vitamins or supplements? The name and how much, if you know. For example vitamin D drops, a multivitamin, iron.

4. Growth

The most recent measurements you have, and when they were taken.

Weight (kg) You can leave this if unsure

That doesn't look right. Please check the units.

Weighed on

Height (cm) You can leave this if unsure

That doesn't look right. Please check the units.

Measured on

Has anyone mentioned concerns about growth or weight?

5. Eating

What does your child eat and drink on a normal day? * Walk me through it: breakfast, lunch, dinner, snacks and drinks, with rough amounts. Brands help.

Please answer this one.

Foods your child loves

Foods your child refuses

Anything you're worried about with eating?

Any other health conditions or medicines? For example eczema creams, reflux medicine, low iron.

6. Pakistan

What are you worried you won't find in Pakistan?

What would you like to come away with from our consultation? *

Please answer this one.

How would you like to meet?

WhatsApp video Google Meet Either

7. Your consent

I agree to Zainab Abbas storing these answers about my child's health to prepare for and give our consultation, as set out in the privacy notice below. *

Please answer this one.

Privacy notice

Who holds your answers: Zainab Abbas

What I collect: What you enter on this form, including details of your child's health, growth and diet.

Why: Only to prepare for and give your consultation, and to follow up afterwards. I don't use it for marketing and I don't share it with anyone unless you ask me to, for example with your child's doctor.

Where it is kept: In a private database in my own Cloudflare account, which only I can access.

How long: Until 12 months after our last consultation, then deleted. You can ask me to delete it sooner.

Your rights: You can ask to see, correct or delete what you've sent me at any time by emailing szainabab@gmail.com or sustainablesehat@gmail.com.