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Let’s ENROLL you with a Quick 5-Minute HEALTH STATUS CHECK FORM!

❤️ Please note: THIS IS A 100% FREE PLAN. Let’s begin!

Step 1: COMPLETE THIS SHORT QUESTIONNAIRE

Since you've decided to Enroll, We start our Client onboarding Process by Identifying known, unknown or ignored Signs & Symptoms to analyze the current state of body's overall health.

This Simple 5 minute Online Questionnaire form gives us a fair idea of what cues & clues your overall health is giving you! Our aim is to gain insight into your health history and background, enabling us to assess how various aspects of your life impact your overall well-being, beyond just your dietary choices.

Step 2: INITAL ASSESSMENTS & LAB REPORT ANALYSIS.

We're keen on Taking references of body's Weight, BMI, Age, food preferences, Allergic conditions, food intolerances & past/ existing medical conditions along with pin-pointing higher or lower than normal levels of important blood tests, urine test or any diagnostic test markers that may be required.

If we feel, you already have done and submitted us the required tests or there isn’t a need to perform any blood tests then we directly approach Step 3 wherein you get a systematic, Realistic, Most Practical, Nature-inspired & Science-based Nutrition & Well-being Plan specially created directly from the Expert Dr. Sharayu.
Step 3: RECEIVE YOUR TAILORED PLAN.
Upon reviewing all relevant signs, symptoms that you’ll mention in this questionnaire, and your lab test results, we will deliver the following information to you within 5-7 business days:

1. An assessment of your current health status

2. A personalized PLAN just for you

If you have any concerns or specific details you would like

to discuss, please don't hesitate to reach out to us on our Customer WhatsApp chat at +919665004839

We are here to assist you every step of the way! VIBRANT WOMEN WELLNESS is committed to providing our clients with the best possible nutrition & wellness care. To do this, it is essential
that your health information is accurate and kept up to date. Could you please assist us in this process by completing
the following personal and health information:

Your Full Name

What's your Age?

Your height ( in feet & inches )

Your body weight ( in kg )

WhatsApp number ( where we can reach you through chat )

Your email address ( on which you wish to receive your PLAN)

You may select one or more of the available options given right below individual questions.

Let’s go!

Do you feel your body weight has changed since last 5 years?
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Occupation

Occupation

Activity levels

Activity levels

Type of activity

Type of activity

Have you ever spoken one-on-one with a dietitian? Choose the most appropriate answer.

Have you ever spoken one-on-one with a dietitian? Choose the most appropriate answer.

What are the PRIMARY/ MAIN CONCERNS for which you have approached us for?

What are the PRIMARY/ MAIN CONCERNS for which you have approached us for?

What are the SECONDARY/ OTHER CONCERNS for which are also bothering you?

What are the SECONDARY/ OTHER CONCERNS for which are also bothering you?

Currently following any type of specific diet?

Currently following any type of specific diet?

Do you wish to lose weight in a specific target area of your body or wish to lose overall body weight?

Do you wish to lose weight in a specific target area of your body or wish to lose overall body weight?

Do you consume?

Do you consume?

How often do you skip meals / do fasting ? Choose the appropriate answer.

How often do you skip meals / do fasting ? Choose the appropriate answer.

Do you have any food allergies or intolerances like lactose/ dairy products/ berries/ peanuts etc? If yes, list below.

Do you take any supplements or vitamins for any health condition or suggested by any doctor? If yes, list below.

What are some of your favorite foods and beverages?

For women of childbearing age:

For women of childbearing age:

Do you have any concerns with your current eating habits? If yes, explain below.

Do you have any concerns with your current eating habits? If yes, explain below.

Water Consumption:

Water Consumption:

Meal patterns

Meal patterns

Usual Breakfast time

Usual lunch time

Usual dinner time

Biggest challenges to reach your nutrition & health Goals are:

Biggest challenges to reach your nutrition & health Goals are:

Mind health

Mind health

Body health

Body health

Skin health

Skin health

Hair health

Hair health

Eye Health

Eye Health

Emotional & Mental health

Emotional & Mental health

Nose health

Nose health

Mouth & Throat

Mouth & Throat

Heart health

Heart health

Lung health

Lung health

Muscle, Joint & Bone health

Muscle, Joint & Bone health

Kidney, Intestines & Urinary tract health

Kidney, Intestines & Urinary tract health

Menstrual & Hormonal health

Menstrual & Hormonal health

Sleep pattern

Sleep pattern

Blood or Urine Levels checked recently within 2 months?

Blood or Urine Levels checked recently within 2 months?

History of Low Vitamins & Minerals:

History of Low Vitamins & Minerals:

Your Medical history:

Your Medical history:

Family history ( mother/father/ sibling )

Family history ( mother/father/ sibling )

Upload File for any Pathology lab reports if you have done them recently within 3 months. If you’re unable to upload here kindly mail us your reports at [email protected] or text us on our Client WhatsApp chat number +919665004839

Stress levels at work or in life?

Stress levels at work or in life?

Which oil do you use for cooking?

Which oil do you use for cooking?

Oil type

Oil type

Do you wish to lose your weight for a specific reason? If yes then choose one or more reasons

Do you wish to lose your weight for a specific reason? If yes then choose one or more reasons

What motivated you to eat healthy, look after your health or change your lifestyle into a healthy one?You can choose one or more options.

What motivated you to eat healthy, look after your health or change your lifestyle into a healthy one?You can choose one or more options.

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