Miyara Onboarding form

Welcome to fitness and lifestyle coaching  program by Miyara.
To make this program work for your body and health and towards your goals, we would like you to fill this form.

The information will be kept confidential and used purely for helping you through this program.

By joining the program and filling this form, you have also accepted the Terms and Conditions(https://www.miyarawomen.com/terms-and-conditions) and Privacy Policy (https://www.miyarawomen.com/privacy-policy) of Miyara Health Pvt. Ltd.

Note that the information provided by you will include personal and medical information that belongs to you and this information will be shared by us with trainers or dieticians or other appropriate service provider partners, so that we can render the best possible assistance to you. Further, the services provided by the trainers or dieticians or other service providers is not medical advise and must not be construed as a replacement for medical advise. Please obtain your doctor’s opinion before you embark on your fitness journey.

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Email *
1. Name:
2. Year of Birth
Country of Residence ( If Others, please specify)
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3. Occupation
4. Weight (in kgs)
5.Height (ft and inches)
6. How do you rate your overall wellbeing?
I desperately need help in all departments of health
I am at the peak of wellbeing
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