Registration Form
Welcome to our exclusive beta testing program for the all-in-one weight management platform! By filling out this registration form, you can secure one of the limited 50 spaces available and gain free access to the platform for 18 months. As a beta tester, you'll have the opportunity to directly influence platform development, receive priority access to new features, and help shape the future of weight management technology. Act fast and join us on this exciting journey towards a healthier lifestyle!
Email
example@example.com
Country
Name
First Name
Middle Name
Last Name
Birth Date
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Year
Gender
Please Select
Male
Female
N/A
Are you currently working with a weight management professional?
Yes
No
Which of the following apply to you?
I am comfortable with my weight
I want to lose 0-5 pounds
I want to lose 5-10 pounds
I want to lose 10-15 pounds
I want to lose more than 15 pounds
What is your current employment status?
Employed full-time
Employed part-time
Self employed
Unemployed
As part of the beta testing, Diat will be collecting data to understand the effectiveness of the experience and improve our product. Is this something you feel comfortable with?
Yes
No
If selected as a beta tester, will you be able to take at least 10-15 minutes a day to explore the features of the app?
Yes
No
Additional Comments or Questions
Submit
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