Personal Information Your name
Age
Gender MaleFemaleOther
Contact Number
Your email
Location (City/Country)
Health & Lifestyle Details
Current Weight (kg)
Activity Level: Sedentary (Little to no physical activity)Lightly Active (1-2 days/week)Moderately Active (3-5 days/week)Very Active (6-7 days/week)
Any Medical Conditions? (e.g., diabetes, thyroid, etc.)
Current Medications(if any):
Do you have food allergies or dietary restrictions? (Please specify)
Preferred Cuisine/Meal Preferences: VegetarianNon-VegetarianVeganOthers
Program Preferences
Dietician Consultation Plan Weight Loss ProgramWeight Gain ProgramWellness & Maintenance ProgramSpecific Condition Program (e.g., Diabetes/PCOD/Heart Health)
Preferred Communication Mode: WhatsAppEmailPhone
Daily Step Challenge Goal (e.g., 5000, 10000 steps):
Would you like a calorie breakdown in your meal plan? YesNo
Additional Services
Daily Reminders & Follow-Ups YesNo
Fitness/Walking Goals Tracking YesNo
Additional Notes or Requirements (Optional):
