Shubhad Wellness & Nutrition

Full Name *

Age *

Gender *
MaleFemaleOther

Mobile Number *

City

Occupation
StudentJobHousewifeBusinessFreelancerFitness EnthusiastOther

Current Weight (kg) *

Height (cm) *

Target Weight

Weight LossFat LossMuscle GainWeight GainDiabetes ControlEnergy ImprovementBetter SleepDigestive HealthSkin & Hair HealthOverall Wellness

Daily Water Intake
Less than 1 Liter1–2 Liters2–3 Liters3+ Liters

Exercise Frequency
Never1–2 Days3–4 Days5+ Days

Sleep Duration
Less than 5 Hours5–6 Hours7–8 HoursMore than 8 Hours

Vegetarian / Non-Vegetarian
VegetarianNon-Vegetarian

Tea/Coffee per Day

Junk Food Frequency

Sugar Intake

Smoking / Alcohol
YesNo

ThyroidDiabetesHigh BPPCOSCholesterolAcidityJoint PainFatty LiverNone

Blood Test Reports / Body Composition Reports

OnlineOfflineWhatsApp Guidance

I agree to be contacted regarding my wellness assessment.