Healthy Lifestyle Programme Healthy Lifestyle Programme Name * Name First Name First Name Last Name Last Name Email * Phone * Date of Birth * Gender * MaleFemaleNon-binary/OtherPrefer not to say Current Weight (kg) * Target Weight (kg) * Height (cm) * Do you have any medical conditions or dietary restrictions? * Diabetes High Blood Pressure High Cholesterol Food Allergies (Specify) Other None Other What are your main health goals? * Weight Loss Muscle Gain Increase Energy Reduce Stress Improve Digestion Better Sleep Overall Wellness How physically active are you? * Sedentary (Little to no exercise) Light Activity (1-2 times a week) Moderate Activity (3-4 times a week) Very Active (5+ times a week) How would you describe your current diet? * Do you have any food allergies or intolerances? * How many meals do you eat per day? 2 or fewer3 meals3 meals + snacks5-6 small meals How would you rate your stress levels? * Do you currently practice mindfulness or meditation? * Yes, regularly Occasionally No, but interested How many hours of sleep do you get on average? * Less than 5 hours5-6 hours7-8 hoursMore than 8 hours What type of support would you like? * Weekly Coaching Calls Meal Plans & Recipes Exercise Plans Mindfulness & Stress Management Techniques Preferred Coaching Style * Strict & StructuredBalanced & FlexibleGentle & Encouraging Choose Your Plan * Basic Plan (Self-Guided Program)Standard Plan (Weekly Check-Ins + Meal Plans)Premium Plan (Full Coaching + Customization) Payment Terms and Conditions * I confirm that the information provided is accurate, and I agree to the terms of the Healthy Lifestyle Programme. Join the Programme If you are human, leave this field blank.
