Lifestyle Assessment Form

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Lifestyle Assessment Form

Don't lose weight to get healthy, but get healthy to lose weight !

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* Indicates required question

Email *

Your email

1. Name *

Your answer

2. Age (Years) *

Your answer

3. Contact Number(Whatsapp Enabled) *

Your answer

4. Email id *

Your answer

5. Height (In centimetres) *

Your answer

6. Weight (In Kgs) *

Your answer

7. Occupation

Sedentary (Desk Job)

Moderately Active (Desk + Field Job)

Very Active (Field Job)

Clear selection

8. City (Please mention the city where you are currently residing) *

Your answer

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