RoyalTea Nutrition Wellness Form

1

Name* This field is required.

First Name

Last Name

2

Phone Number* This field is required.

Please enter a valid phone number.

3

Email* This field is required.

example@example.com

4

Gender* This field is required.

Female

Male

5

Height* This field is required.

6

Weight* This field is required.

7

Target Weight* This field is required.

8

What are your health & wellness goals?* This field is required.

Lose weight

Improve overall nutrition

Lean & fit

Build muscle

9

How many meals do you eat in a day?* This field is required.

1

2

3 or more

10

How much water do you drink in a day?* This field is required.

2 bottles (32 oz)

4 bottles (64 oz)

8 bottles (1 gallon)

11

How often do you exercise?* This field is required.

None

2x a week

3x a week

5x a week

12

Do you have social media profiles?* This field is required.

YESNO

13

What are your social media profiles?* This field is required.Only used for testimonials

14

What’s your budget? * This field is required.

15

Would you like to schedule a consultation to further discuss suggested plans tailored to your budget?* This field is required.

YESNO