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Home
New customer registration
Log my diet
Useful Info
Health Indicators
FAQ
Recipes
Blog
Contact Us
Enquiry
Appointment
Contact
Customer Registration for Holistic Diet
Personal Details
Parent Details
Current disease details
Anthropometric Measurements
Lifestyle Details
How is activity level?
Active
Moderate
Sedentary
Food preferences?
Vegetarian
Non-Vegetarian
Eggetarian
Vegan
Do you get enough sleep (7-8 hr/daily)?
Always
Sometimes
Never
Do you eat fruits & salad 3 times/day?
Always
Sometimes
Never
Do you drink 8-9 glasses of water/day ?
Always
Sometimes
Never
Do you eat chicken, mutton or other non-veg items daily?
Always
Sometimes
Never
Do you exercise daily for 30-40 min?
Always
Sometimes
Never
Do you walk daily for 45 mins in moderate speed to brisk?
Always
Sometimes
Never
Are you calm and controlled daily?
Always
Sometimes
Never
Do you smoke daily?
Always
Sometimes
Never
Do you drink alcohol daily?
Always
Sometimes
Never
Your social life / going out with friends?
Daily
Weekly
Monthly
Occasionally
Never
Do you fast?
Weekly
Monthly
Occasionally
Never
Do you like cooking at home?
Always
Sometimes
Never
Do you eat out or order food?
Always
Sometimes
Never
Do you skip any meals?
Always
Sometimes
Never
Do you eat dry fruits?
Always
Sometimes
Never
Do you eat late at night?
Always
Sometimes
Never
Do you use mouth wash?
Always
Sometimes
Never
Do you feel lethargy, sleepy & weak?
Always
Sometimes
Never
Do you have hair fall/skin problem?
Always
Sometimes
Never
Special food items frequencies
Crackers, Waffers, Chips?
Fruit juices/soda/fanta/cola?
Biscuits?
Papad/Pickles?
Butter/Ghee?
Ice Cream/Cold Drinks?
Fast Food Frequencies
Burgers?
Pizza?
chats?
pavs?
Submit
Save
7776994261
support@holisticdiet.co.in
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