Wellness Profile
Participant Name
*
First Name
Last Name
Gender
*
Male
Female
Other
Active Email ID
*
example@example.com
Birthday
*
Upload your
FRONT PROFILE
one day before the Challenge starts using
SHAPEZ APP
(as shown above)
*
Browse Files
Cancel
of
Upload your
BACK PROFILE
one day before the Challenge starts using
SHAPEZ APP
(as shown above)
*
Browse Files
Cancel
of
Upload your
SIDE PROFILE
one day before the Challenge starts using
SHAPEZ APP
(as shown above)
*
Browse Files
Cancel
of
EXAMPLE OF HOW TO TAKE YOUR VIDEO
Upload your
Video
as shown before
*
Browse Files
Cancel
of
Upload your
Before photo
like the example shown before, for
RECOGNITION PURPOSE
*
Browse Files
Cancel
of
Current Lifestyle
How is Current Lifestyle?
*
Stress Free
Stressed
High Energy
Low Energy
What Time of the Day you Feel Tired?
*
Morning
Noon
Evening
Night
All day
If Yes, Where?
If Yes, For What?
If Yes, Please Specify?
Are you?
*
Veg
Non-Veg
Other
How many litres of water do you consume per day?
*
How many Cups of Tea/Coffee do you consume per day?
*
How many Meals & Snacks do you consume per day
*
How is your Digestive Health?
*
Regular Bowel Movement Everyday
Constipation
Frequent Loose Motions
Indigestion
Acidity / Constant Burps
Gastric / Constant Flatulence
Other
If Yes, please specify
How many Servings of Fruits & Vegetables do you consume per day
*
Number of Meals eaten out or delivered in per week
*
Number of Hours of Sleep per Night
*
Number of Times per week of at least 30 min Exercise ?
*
None
1-2 days
3-4 days
5+ days
Which of these applies to you
*
Very Inactive (Hardly any travel and mainly a desk job)
Mildly Inactive (Desk job, but travel during the daytime)
Light Activity (Job is mainly standing and/or light workout 1-3 days per week)
Moderate Activity (Workout 3-5 days per week with light physical activity at work)
High Activity (High Intensity exercises 4-6 days per week)
Extreme Activity (High Intensity exercises 6 days per week and work is physically rigorous!)
If Yes, Please Specify what do you crave and at what time of the Day
What
made you Gain / Lose Weight?
*
Sedentary Lifestyle
Eating Habits
Post Pregnancy
Post Surgery
Post medication
Post illness
Emotional Trauma
Other
Why
do you want to Gain / Lose Weight now?
*
Doctor advised
Job Requirement
Special Occasion (Ex: Wedding)
Want to take charge of my Health
Other
What are your
Wellness Goals
?
*
Weight Loss
Weight Gain
Fat Loss
Build Muscle
Toned Body
Inculcate Healthy Habits & Lifestyle
Enjoy Longterm Wellness
Be Healthy & Happy
Follow up is Crucial for Transformation
. What do you prefer from the following?
*
Multiple times a day
Once a day
Once a week
Twice a week
Other
Kindly specify a preferred time to contact to avoid spamming
*
Submit
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