What’s your ideal weight?
Ideal Weight?
What’s your height and weight?
Height
Weight
What’s your gender and age?
Age
What’s your body circumference
Waist
Hip
How motivated are you in achieving your desired weight?
How frequent do you exercise?
Which of these represent your exercise routines?
What time do you normally sleep at night?
Sleep Time
7pm 8pm 9pm 10pm 11pm 12am 1am 2am 3am
How many hours do you normally sleep?
How is your appetite?
Are you tolerant to cold?
Do you feel heavy and lethargic?
Do you experience breathlessness or shortness of breath easily?
Which best describes your overall mood?
How many servings of vegetables you eat per day?
How many servings of fruits you eat per day?
How many servings of meat / protein you eat per day?
How many servings of carbohydrates you eat per day?
How many glasses of water you drink per day?
Which of the below represents your eating habits?
You may pick more than one.
Your Name*
Email Address*
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