Diet Form

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Finish

Name *

Phone *

Email Address *

Age *

Gender *

Height (in cm) *

Weight (in kg) *

Are you a *

Query / Compliant *

Occupation

Wake up time & Bed Time *

How often do you eat these and how much? (In ml or grams)? (Milk, Curds, Buttermilk, Paneer, Butter, Cheese) *

How often do you eat meat (Chicken Mutton Beef Pork Fish Prawns Eggs) and how much? (Fried, Baked, Roasted or Grilled) *

How often to do eat Green leafy vegetables like spinach, fenugreek leaves, mint leaves, etc. and how much? *

How often you include vegetables in your diet and how much? *

How often do you include potatoes, yam, sweet potato in the diet? (In what form: deep fried, shallow fried, curry form)? *

How often do you consume fruits, which fruit and in what form? (Mixed salad, fruit juice, shakes) *

How often do you include split dals like Tur dal, Urud dal, Channa dal and how much? *

How often do you include Whole gram pulses like Rajma, Lobia, Channa, etc. and how much? *

How often you include Wheat, Ragi, millets in food and how much? *

How much of oil do you purchase for a month and what kind of oils do you use? *

How much of Sugar do you use for a month? *

How many members stay at your home? *

How much of water do drink in a day? *

Do you drink tea, coffee, Horlicks or health drinks? How much/when? *

Do you dine out? How frequently? *

How often you eat fried foods, snacks (chats), and sweets? *

Do you smoke or consume alcohol? If yes, specify: *

Any Food Allergies, Medical Issues, or Medications? *

Do you exercise? How long and what activities? *

If you are stressed, what do you do to relieve yourself? *

24hour-Diet Recall: (From yesterday's wake up time till bed time, tell me as what did u eat for breakfast, lunch and dinner, and in between if you have had something and your activities) *

Declaration *
I, hereby declare that the information furnished above is complete and correct to the best of my knowledge and belief. I understand that any information that is not been revealed now may affect my result. I have been clearly explained in my understandable language the methods of weight loss and any deviations will affect the result. I also understand and agree that there will be no refunds for any reason.

Frequently Asked Questions

Here are some common questions about our services and approach to healthy eating.

Frequently Asked Questions

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