Registration form for Diet Plan
Please provide the details below. All the information provided will be secured and only be used for record keeping of our clients. Moreover, it will help in preparing the best suitable diet plans for our clients.

*Charges*

One time Diet Plan (eg. For anemia) Charges are Rs 700/-

Recurrent Diet Plan (eg. For weight loss/gain) Charges depends upon the duration of weeks or months.
Rs. 1000/- for two weeks.
Rs. 1500/- for one month.

Payment will be done in advance upon receiving the notification that the diet plan is ready and information on payment modes will be shared then.

*Delivery*

Processing and delivery of the diet plan can take 1-3 days.
Diet plans will be delivered on the email address/whatsapp number provided by the client.

For any queries you can DM on gmail or instagram
Email *
Clear selection
Name *
ADDRESS *
WHATSAPP NUMBER *
GENEDER *
AGE *
HEIGHT *
Current Weight *
Occupation *
*If you are a student then mention whether you are a day scholar or live in a hostel
For which condition or disease do you require a diet plan? *
Example includes weight loss, weight gain, anemia, diabetes, hypertension, lactose intolerance, hepatitis, kidney disease, Poly cystic ovary disease, etc.
Do you want a "One time plan" or "Recurrent plans on weekly or monthly basis" *
One time plan means if you want a diet plan for anemia, it will be a single plan including multiple food options and all the instructions to follow considering anemia. Recurrent plans comprise of diet plans based on different calories for specific period of days which will be changed and given after each specific duration of days are completed; for example 4 weeks diet plan for weight loss, etc.
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy