Consent Form
* Required
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Name *
Email *
Phone number *
Age *
Address *
Profession *
Sex *
Country/location *
Weight in kgs *
Height in inches *
Medical history *
General info like stress/acidity/constipation etc *
On any regular medications like Bp/thyroid/pcod/anxiety or depression etc *
Surgery *
Wake up time *
Time
:
Sleep time *
Time
:
Working hours *
Time
:
Workout time *
Time
:
Workout type *
Outings per week *
Food allergies *
Food cravings *
Reference *
Preference for heavy meal *
Water intake in litres *
Smoke *
Food Type *
Routine of eating from early morning till night *
Diet receiving options what's app or video calling (by prior appointment) *
Package opted *
I Miss/Mrs. /Master /Mr give consent to diet chemistry to provide counseling or diet to myself or the client for which I am legally responsible. If due to any reason I client do not continue the plan. In that condition money will not be refunded. Your opted package is only valid for 1 month extra. After that grace period your package will discontinue. Only on medical grounds (with reports and doctors approval) if you discontinue your package for a month, your package will be converted into maintenance package.I agree to the above conditions YES/NO. *
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