Health PROFILE Form
Please fill accurate information to help us serve you better.
Waist Size (use an inch tape and measure around your waist circumference around naval ):
What are you looking for in Weight Management?
Weight Loss with Fat Loss
All the Above
Any specific concerns about your health other than weight management?
Are you on medication? If yes, please mention the concern
Do you engage in any physical activities? What type of activity?
How often in a week do you exercise?
Less than 2 days / week
3 days / week
More than 3 days / week
How many minutes do you allocate for exercise in a day?
Less than 30 mins
Up to 60 mins
More than 60 mins
Do you skip meals? If yes please provide the reason
Briefly describe your work profile.
What is the nature of your work?
Mix of both
Have you tried anything to lose/gain weight before? What was the result?
What is your preferred time for consultation ? (Timings in IST)
10 AM - 1 PM
1 PM - 4 PM
4 PM - 7 PM
7 PM -10 PM
To help us understand you better, anything else you would want us to know about you?