Weight (in kg)
Diet pattern-Bed TeaBreakfastMid MorningLunchEvening TeaDinner
Do you eat out? If yes, how frequently?
How much water do you take per day?
Any food allergy?
Vegetarian or Non-Vegetarian
What health condition would you like us to help you with?
Weight LossWeight GainHigh Blood PressureDiabetesHigh Uric AcidThyroid DisorderLiver DisorderKidney DisorderHeart DiseaseHigh CholesterolPCODInfertilityArthritisNone of These
Any other condition you want us to help you with?
Are you taking any medicines? If yes, Name them
Are you taking any supplements? If yes, Name them
Are you Addicted to Tea / Coffee?
Do you consume Alcohol or smoke? YES/ NO If Yes, How Often?
Are You working ?
Which kind of job ?
Do you Perform any kind of physical activity ?
Any other specification?
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