Help Us in Getting To know You :)
Your Name *
Your answer
Your Email ID *
Your answer
Your Age *
Your answer
Sex *
Height (in cms) *
Your answer
Weight (in kg) *
Your answer
Measurement of abdomen in Cms (1 inch above naval) *
Your answer
Measurement of abdomen in Cms (1 inch Below naval) *
Your answer
Measurement of abdomen in Cms ( At naval) *
Your answer
Measurement of Hips in cms ( At the fullest area) *
Your answer
Measurement of thighs In cms ( Center point on thigh from knee to hip bone) *
Your answer
Type of Food *
Medical Problem (if any)
(ex - diabetes , blood pressure, thyroid, pcod, pcos, metablic dysfunction, heart ailment, etc )
Your answer
Medications (if any)
(name of the medicine, dosage and timings)
Your answer
Any food item in particular you want us to avoid completely
(items you dislike or avoid eating or are allergic to)
Your answer
who does the cooking at home? *
mother, wife, self, cook, always eat in restaurants/ mess/ canteen
Your answer
Office timing ? ( please count in the travelling time as well )
Your answer
Your current LifeStyle *
ex- wake up - 7.00 am, bed tea - 7.30 am with cream biscuits 2 # , breakfast 9.30 - 1 medium plate poha with 1 cup tea and biscuit, 10.00 am office, sedentary work, 11.30 tea .. and so on
Your answer
For lunch (during weekdays) You generally
Do you exercise ? play a sport ? do yoga or walking ?
Please mention the activity, total duration and time at which that activity is done. how many days in a week it is done.
Your answer
Any message for us ?
Your answer
What is your Goal?
ex - lose 5 kgs , lose tummy fat, lose double chin etc.
Your answer
What kind of cuisine you follow at home ?
ex- maharashtrian , andra, gujrati, north indian, south indian.
Your answer
Which City do you reside in ? (This will help us in understanding the availability of food items around you)
Your answer
How did you get to know about Dietburrp ?
Your answer
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