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Health Evaluation
This will help us evaluate your health quotient.
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* Indicates required question
Email address
*
Your answer
Name
*
Your answer
Age
*
Your answer
Height
*
Your answer
Current Weight
*
Your answer
Target Weight
Your answer
How would you describe your eating habits ?
*
Balance Diet(Includes right amount of carbs, fat and proteins)
Unhealthy Diet(Eats majority of junk food)
Poor Diet(Stays hungry or very less food)
Other:
Required
Have you even been on a Diet ?
*
Yes
No
Maybe
How often do you workout in a week? (May include jogging and walking)
More than three times in a week
Thrice a week
Twice a week
Never
Other:
Clear selection
How often do you consume Alcohol?
*
Daily
Once a week
Once a month
Never
What is your health goal ?
*
Loose weight
Maintain current weight
Gain Muscles / Get toned
Gain Strength
Become Thin
Be Disease free
Overall Wellness
Required
Do you wish to be a part of our 30 days fitness program ?
*
Yes
No
Maybe
Would you like to recommend someone else for the fitness / weight loss plan ? If yes, please mention their details.
*
Your answer
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