Welfare Fitness Studio - Diet Assessment Form Welfare Fitness Studio Diet Assessment & Intake Form Section 1: Personal Information (व्यक्तिगत जानकारी) 1. Full Name (पूरा नाम) * 2. Age (उम्र) * 3. Gender (लिंग) * Male Female Other 4. Mobile / WhatsApp Number * 5. Email ID 6. What is your Profession/Work Profile? (आप क्या काम करते हैं?) Section 2: Health Goals & Body Metrics (लक्ष्य और शरीर का माप) 7. Current Weight in Kgs * 8. Height * 9. What is your Main Goal? * Weight Loss Weight Gain Muscle Building Manage Medical Condition Healthy Lifestyle Any other specific goal?: Section 3: Daily Routine & Lifestyle 11. Waking up Time 12. Sleeping Time 13. Are you working / Office going? Yes No Work from Home 14. If Office going, what are your timings? 15. Do you carry home-cooked food to office? Yes, always No Sometimes 16. Do you exercise? No exercise Walk/Yoga Gym/Heavy Workout Section 4: Dietary Preferences & Budget Economic Class Preference * Lower Middle Class Middle Class Upper Middle Class 17. Food Preference * Pure Veg Eggitarian Non-Veg 18. Do you have any Food Allergies? 19. How many cups of Tea/Coffee do you drink daily? 20. Diet Plan Preference Simple Home Food Exotic Items Included 21. Budget for Supplements/Nutrition Yes, flexible Only basic vitamins Kitchen-based only Section 5: Medical History & Family Health 22. Any current medical issues? * Diabetes Thyroid PCOD/PCOS High BP Uric Acid / Joint Pain Digestion/Acidity 23. Are you taking any regular medicines? 24. Family Health History 25. For Female Clients Only: Obstetric History Not Applicable Normal Delivery C-Section Delivery Currently Pregnant Submit Details Thank You! Your details have been submitted successfully.