Weight Management Programme weight-management-programme Name * Name First Name First Name Last Name Last Name Email * Phone * Date of Birth * Primary Goal * Lose Weight Gain Weight Maintain a Healthy Weight Improve Body Composition (Muscle vs. Fat Ratio) Current Weight (kg) * Target Weight (kg) * Height (inches) * Target Timeline * 1-3 months3-6 months6+ months Daily Activity Level * Sedentary (Little to No Exercise)Lightly Active (1-2 Workouts Per Week)Moderately Active (3-4 Workouts Per Week)Very Active (5+ Workouts Per Week) Current Exercise Routine * Do you have any physical limitations or medical conditions? Diabetes High Blood Pressure Thyroid Issues PCOS None Other Other What type of diet do you currently follow? Balanced DietHigh ProteinLow CarbKetoVegan/VegetarianMediterraneanOther Other Do you have any dietary restrictions or allergies? Dairy-Free Gluten-Free Nut Allergy None Other Other Get Fit How many meals do you eat per day? 23456+ Biggest Challenges with Nutrition * Emotional Eating Late-Night Snacking Lack of Meal Prep Time Eating Out Too Often Sugar Cravings Do you track your food intake? Yes No How many hours of sleep do you get per night? Less than 55-67-88+ Do you experience stress or emotional eating? Yes No How motivated are you to make lifestyle changes?(Scale 1-10) Meal Plan Preferences * Quick & Easy Meals Budget-Friendly Options Meal Prepping Plans Family-Friendly Meals Exercise Preferences * Home Workouts Gym-Based Workouts Outdoor Activities Low Impact (Yoga/Pilates) Package Selection Basic Weight Management Plan 15000Advanced Plan with Coaching 25000Premium Plan with Weekly Adjustments 40000 Payment Terms and Condition I confirm that the information provided is accurate, and I agree to the terms of the Weight Management Programme. If you are human, leave this field blank.
