Personalized Diet and Fitness Plans

Please fill the form provided below for your personalized plan today.

Name:............................................................................

Age.......................................

Gender..................................

Weight.......................................(Kg)

Height........................................(cm)

Chronic Diseases/ Ailments..........................................................................................

Weekly work/ school schedule

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 How often do you exercise now?

Never

Occasionally

1 – 3 days a week

4 – 6 days a week

 Which cardio activities do you enjoy (or at least don't hate)? (Check all that apply.)

Aerobic dancing	Power walking	Swimming
Bicycling	Rowing	Playing sports
Elliptical training	Running	Kickboxing
Jumping rope	Stair stepping	None

 Which type of foods do you crave? 

Fruit, bread, and crackers

Salty foods, cheeses, and meats

Both of these

Are you an "emotional eater?"

Yes

No

I don't know