HEALTH AND LIFESTYLE
Take care of your body. It's the only place you have to LIVE
Name and Age
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Name of the person from whom you got this link?
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DAILY ROUTINE ANALYSIS
Type of Work/Lifestyle
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Work from home (WFH) or Hybrid mode
Work from Office (WFO)
Travelling/Field Work
Student/Homemaker Staying at home
At what time do you have breakfast every day?
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Before 8AM
8AM - 9AM
9AM - 10AM
After 10AM
What is your water intake per day?
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Less than 2 litres
2-3 litres
More than 3 litres
Your sleep hours?
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Less than 4 hours
4-6 hours
6-8 hours
More than 8 hours
Are you facing any of the following problems?
Hair fall
Skin issues (Pimples, acne, dark circles, dry skin, rashes)
Headache (Sinus/Migraine/Tension/Cluster)
Heavy or irregular periods (PCOD/PCOS)
Stress/Mood swings/Cravings
Gastric/Bloating
Constipation/Diarrhea
Obesity/Over weight
Under weight
Joint pain (neck pain, back pain, knee pain, etc.)
Hormonal Imbalance/Thyroid
Asthma/Wheezing
Diabetes/BP/Cholesterol/Stroke
Low Immunity/Weakness
Depression/Anxiety
Other
If Other, kindly mention the specific problem
Are you on medication for any of the above problems?
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Yes
No
If yes, kindly mention for which problem and for how long you have been on medications.
Are you interested in improving your health and lifestyle?
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NO
YES
In order to analyze your BMI, kindly enter your weight (kgs) and height (cms).
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Are you happy with your current weight?
Yes
No
Currently, what do you want to learn and implement to lead a healthy and happy life?
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Healthy habits and better lifestyle
Food and Calorie management
Weight and Health management
Family and Relationship management
Time and Money management
Stress management
People and Children management
Personality Development and Better communication
How healthy do you rate yourself out of 1-10
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Do you think FOOD plays an important role in health and weight management?
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Mobile (Whatsapp number preferred)
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City and State
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If we educate and guide you to lead a healthy and active lifestyle, are you interested in living your best life?
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No
Yes
I will visit the health club, check my wellness profile, and will then decide.
Submit
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