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Services
Testimonials
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Contact
Enquiry Form
"
*
" indicates required fields
1
Basic Info.
2
To improve health
3
Stress Level
4
Food Preferences
Name
*
Age
*
Gander
*
Male
Female
Transgender
Prefer not to say
Contact Number
Current weight
*
Email Address
*
Address
*
Height in cm
*
Waist in cm
Hips in cm
Sleep time
Hours
:
Minutes
AM
PM
AM/PM
Wake up time
Hours
:
Minutes
AM
PM
AM/PM
Workout time (Optional)
Hours
:
Minutes
AM
PM
AM/PM
Physical Activity
Strength Training
*
None
Low
Moderate
High
Cardio/Aerobics
*
None
Low
Moderate
High
Stretching/Yoga
*
None
Low
Moderate
High
Sports/Leisure
*
None
Low
Moderate
High
Physical Activity - No. of Days/Week and Duration
To improve your health, on a scale of 1 to 5, '1- Not willing' and '5- Very willing', how ready/ willing are you to:
Significantly modify your diet
*
1
2
3
4
5
Take nutritional supplement each day
*
1
2
3
4
5
Keep a record of everything you eat each day
*
1
2
3
4
5
Practice relaxation techniques
*
1
2
3
4
5
Engage in regular exercise/ physical activity
*
1
2
3
4
5
Wellness Goals - Indicate which fitness goals interest you
*
Weight management
Stress management
Immunity enhancement
Increased strength and muscle mass
Fatloss
Improve Skin/Hair Health
Stress Level, on a scale of 1 to 10, '1- Extremely Low' and '10- Extremely High':
Work /Studies
1
2
3
4
5
6
7
8
9
10
Family
1
2
3
4
5
6
7
8
9
10
Social
1
2
3
4
5
6
7
8
9
10
Financial
1
2
3
4
5
6
7
8
9
10
Health
1
2
3
4
5
6
7
8
9
10
On average how many hours sleep do you get?
*
Do you smoke?
Never
Currently
In the past
If yes, quantity/frequency (Please Specify)
Food Preferences:
Your meal may include:
Eggs
Chicken
Paneer
Fish
Cheese
Milk
Curd
Cooking Oil Preferences
Ghee
Butter
Coconut oil
Dietary Restriction
Due to Health
Culture
Religious
Intense dislike towards a particular type of food?
Highly sensitive to any particular food
Give Details
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