Femly — Standard Diet Intake Form
Femly — Standard Diet
Draft saved
Section 1 of 6 0%
🌿 Take your time with this form Your detailed assessment is very important for us to support your health effectively — every answer helps us personalise your care.
Section 1 of 6
Contact & Identity
Your basic details help us set up your profile.
Please enter your full name
Please enter a valid email
Please enter a valid phone number
Enter your number without the country code or spaces.
Can't find your pincode? Enter manually
Section 2 of 6
About You
Help us personalise your program to your body.
in kg
in kg
Section 3 of 6
Medical & Health
This helps your dietitian personalise your plan safely.
Common: Metformin / Thyroid meds / BP meds / Vitamins / Contraceptives / None
🔬
Drag & drop or browse files
PDF, JPG, PNG — max 10MB each
Section 4 of 6
Diet & Food Preferences
We'll build your plan around foods you actually enjoy.
6 glasses
Section 5 of 6
Goals, Activity & Sleep
Your goals, readiness, and sleep patterns help us keep you on track.
Section 6 of 6
Progress Photos & Closing
Photos help us track your transformation accurately.
📸 Photo Instructions

✅ Stand against a clear background / wall
✅ Wear a fitted T-shirt and pyjama / shorts
✅ Stand straight with arms slightly away from body
✅ Take in good natural light
❌ Avoid black clothing
❌ No mirror selfies

All photos are stored securely and visible only to your assigned dietitian and coach.
🧍
Front
Face the camera directly
🚶
Back
Turn fully away from camera
👤
Left Side
Turn left side to camera
👤
Right Side
Turn right side to camera
Please accept the terms to continue
Your data is encrypted and handled in accordance with Femly's privacy policy.
🌸
You're all set!

Your health profile has been submitted to the Femly team.

Your assigned health consultant will reach out within 24 hours to schedule your first call.

Thank you for trusting Femly with your health journey.

Reference ID: