Your Bio-Audit Intake Form

Your Bio-Audit Intake Form - ₹199

Takes 4–5 minutes. Your answers help Dr. Bansi prepare a personalized 12-page clinical report. Tastifit · Dr. Bansi Shah Parikh
About You

Basic details for your report
Full Name

First NameLast Name
Email Address
The report will be sent to this email address
Whatsapp Number

Area CodePhone Number
Gender
Age
Primary Health Concern

Other(s) - Please specify

Your Last 3 Days of Eating

Be honest — there are no wrong answers here
Why this matters: Dr. Bansi reads patterns, not perfection. Your honest answers help her identify exactly what's driving your symptoms.
Typical Breakfast
What did you eat for breakfast in the last 3 days?
Typical Lunch
What did you eat for lunch in the last 3 days?
Typical Dinner
What did you eat for dinner in the last 3 days? Please mention if alcohol is part of dinner
Snacking & In-Between
Tea, coffee, biscuits, fruit, anything
Water Intake per day - Approximate litres

Your Goal & One Last Thing

Helps Dr. Bansi personalise your report completely
What does success look like for you in 90 days?
Be specific — this becomes the target in your report
What have you already tried?
Diets, supplements, workouts — what worked, what didn't
Anything else Dr. Bansi should know?
Allergies, food restrictions, lifestyle constraints, anything
What happens next: Dr. Bansi personally reviews your answers and prepares your 12-page SĀRVAHITA Bio-Audit Report. You will receive it on WhatsApp & email within 48 hours.
By submitting this form you acknowledge the below:
- This is only a primary analysis based on the data declared and provided by you.
- This does not include solutions, or how to fix verdict.
- No medicines or meal plans or fitness related plans will be provided in this activity.
Should be Empty:

Your Bio-Audit Intake Form - ₹199