Full Name & Surname *Age1011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859606162636465666768697071727374757677787980Date of Birth *Gender *FemaleMalePrefer not to sayHeight (In Centimetres)130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190Current Weight (In Kgs) *Select Your Country CodeAfghanistan - 93Albania - 355Algeria - 213American Samoa - 1-684Andorra - 376Angola - 244Anguilla - 1-264Antarctica - 672Antigua and Barbuda - 1-268Argentina - 54Armenia - 374Aruba - 297Australia - 61Austria - 43Azerbaijan - 994Bahamas - 1-242Bahrain - 973Bangladesh - 880Barbados - 1-246Belarus - 375Belgium - 32Belize - 501Benin - 229Bermuda - 1-441Bhutan - 975Bolivia - 591Bosnia and Herzegovina - 387Botswana - 267Brazil - 55British Indian Ocean Territory - 246British Virgin Islands - 1-284Brunei - 673Bulgaria - 359Burkina Faso - 226Burundi - 257Cambodia - 855Cameroon - 237Canada - 1Cape Verde - 238Cayman Islands - 1-345Central African Republic - 236Chad - 235Chile - 56China - 86Christmas Island - 61Cocos Islands - 61Colombia - 57Comoros - 269Cook Islands - 682Costa Rica - 506Croatia - 385Cuba - 53Curacao - 599Cyprus - 357Czech Republic - 420Democratic Republic of the Congo - 243Denmark - 45Djibouti - 253Dominica - 1-767Dominican Republic - 1-809, 1-829, 1-849East Timor - 670Ecuador - 593Egypt - 20El Salvador - 503Equatorial Guinea - 240Eritrea - 291Estonia - 372Ethiopia - 251Falkland Islands - 500Faroe Islands - 298Fiji - 679Finland - 358France - 33French Polynesia - 689Gabon - 241Gambia - 220Georgia - 995Germany - 49Ghana - 233Gibraltar - 350Greece - 30Greenland - 299Grenada - 1-473Guam - 1-671Guatemala - 502Guernsey - 44-1481Guinea - 224Guinea-Bissau - 245Guyana - 592Haiti - 509Honduras - 504Hong Kong - 852Hungary - 36Iceland - 354India - 91Indonesia - 62Iran - 98Iraq - 964Ireland - 353Isle of Man - 44-1624Israel - 972Italy - 39Ivory Coast - 225Jamaica - 1-876Japan - 81Jersey - 44-1534Jordan - 962Kazakhstan - 7Kenya - 254Kiribati - 686Kosovo - 383Kuwait - 965Kyrgyzstan - 996Laos - 856Latvia - 371Lebanon - 961Lesotho - 266Liberia - 231Libya - 218Liechtenstein - 423Lithuania - 370Luxembourg - 352Macau - 853Macedonia - 389Madagascar - 261Malawi - 265Malaysia - 60Maldives - 960Mali - 223Malta - 356Marshall Islands - 692Mauritania - 222Mauritius - 230Mayotte - 262Mexico - 52Micronesia - 691Moldova - 373Monaco - 377Mongolia - 976Montenegro - 382Montserrat - 1-664Morocco - 212Mozambique - 258Myanmar - 95Namibia - 264Nauru - 674Nepal - 977Netherlands - 31Netherlands Antilles - 599New Caledonia - 687New Zealand - 64Nicaragua - 505Niger - 227Nigeria - 234Niue - 683North Korea - 850Northern Mariana Islands - 1-670Norway - 47Oman - 968Pakistan - 92Palau - 680Palestine - 970Panama - 507Papua New Guinea - 675Paraguay - 595Peru - 51Philippines - 63Pitcairn - 64Poland - 48Portugal - 351Puerto Rico - 1-787, 1-939Qatar - 974Republic of the Congo - 242Reunion - 262Romania - 40Russia - 7Rwanda - 250Saint Barthelemy - 590Saint Helena - 290Saint Kitts and Nevis - 1-869Saint Lucia - 1-758Saint Martin - 590Saint Pierre and Miquelon - 508Saint Vincent and the Grenadines - 1-784Samoa - 685San Marino - 378Sao Tome and Principe - 239Saudi Arabia - 966Senegal - 221Serbia - 381Seychelles - 248Sierra Leone - 232Singapore - 65Sint Maarten - 1-721Slovakia - 421Slovenia - 386Solomon Islands - 677Somalia - 252South Africa - 27South Korea - 82South Sudan - 211Spain - 34Sri Lanka - 94Sudan - 249Suriname - 597Svalbard and Jan Mayen - 47Swaziland - 268Sweden - 46Switzerland - 41Syria - 963Taiwan - 886Tajikistan - 992Tanzania - 255Thailand - 66Togo - 228Tokelau - 690Tonga - 676Trinidad and Tobago - 1-868Tunisia - 216Turkey - 90Turkmenistan - 993Turks and Caicos Islands - 1-649Tuvalu - 688U.S. Virgin Islands - 1-340Uganda - 256Ukraine - 380United Arab Emirates - 971United Kingdom - 44United States - 1Uruguay - 598Uzbekistan - 998Vanuatu - 678Vatican - 379Venezuela - 58Vietnam - 84Wallis and Futuna - 681Western Sahara - 212Yemen - 967Zambia - 260Zimbabwe - 263Whatsapp Number *Email Address *Residential Address *(For Invoice Purpose)Profession *Your Working Hours(E.g., 9–5, 10–7, shift-based)When is your wedding?Preferred Diet Type *VegetarianVeganNon-VegetarianEggitarianOtherCuisine Commonly Cooked at Home *(E.g., North Indian, South Indian, Maharashtrian, etc.)Favourite Foods *Foods You Dislike *Trigger Foods *What do you prefer? *Trying new, tasty, healthy food recipes dailyBasic, repetitive meals (dal, roti, sabzi, rice)A combination of bothWho usually prepares your meals? *MyselfParentCook / House StaffOtherHow often do you eat out or order in? *Once on weekends2–3 times a weekAlmost every dayVery rarelyHow much tea/coffee/soft drinks/juices do you consume regularly? *Do you drink alcohol or smoke? If yes, how often? *Water intake per day *1 Litre / ~3 glasses2 Litres / ~6 glasses3 Litres / ~9 glasses4 Litres / ~12 glassesNot measured, but likely highNot measured, but likely lowFrequency of bowel movements (poop) per day? *01234OtherDo you have any existing medical or lifestyle conditions? *Any past medical conditions? *Any hereditary/genetic medical conditions? *Do you have any food allergies? *Are you currently taking any medications? Please include name & dosage. *Do you have any skin or hair-related concerns? *Describe your menstrual cycle. Are your periods regular or painful? *Please upload your recent blood test reports (If Available)(Up to 5 files; max size 100 MB per file)Drag and Drop (or) Choose FilesWhat is your goal body for the wedding? *(E.g., toned arms, fat loss, glowing skin, fitting into your dream outfit, etc.)How do you see your health and body one year from now? *When are you most hungry during the day? *How is your mood throughout the day? *Happy and chirpyAlways stressedMoody and crankyOften feel depressedNeutral / mediumHow would you describe your personality? *What helps you relieve stress? *(e.g., meditation, walking, playing with your dog)Describe a day in your life — routine, meals, work, sleep, etc. *Have you followed any diet plans in the past? What kind and how was the experience? *If you could change 3 things about your current lifestyle or nutrition, what would they be? *One habit in your lifestyle that you are proud of? *What activity do you prefer? *WalkingExercisingCombination of bothAre you ready to exercise along with your diet? *YesNoMaybeDoes your partner/family support your transformation journey? *YesNoMaybeOtherAre you willing to give 80–100% dedication to your transformation journey? *YesNoMaybeHow would you like your diet plan to be structured? *Macro-based (Calories, proteins, carbs, fats)Micro-based (Vitamins, minerals, micronutrients)Option-based (Meal choices and alternatives)Themed (e.g., “Fortnite-style”, gamified or challenge-based)Fixed (Pre-set weekly or fortnightly plans)What kind of support or check-ins do you prefer? *Daily check-ins / reminders (“daily poke”)Weekly progress reviews (“weekly connect”)Bi-weekly connectsAs-needed onlyOtherWhat are your expectations from me as your coach/nutritionist? *(Guidance, accountability, motivation, emotional support—share openly)What is the duration of the program you’ve enrolled for? *(E.g., 1 month, 3 months, 6 months)Package Name & Payment Amount *Any other information you'd like to share or highlight?Please upload full-body pictures in tight-fitted clothing (front, side, and back)> Avoid mirror selfies or black clothes >Upload up to 5 files. Max 100 MB each.Drag and Drop (or) Choose FilesWhere did you hear about Nutritionist Saloni? *InstagramWebsite (www.nutritionistsaloni.com / http://www.nutritionistsaloni.com)Referred by someoneAdsOtherPlease SpecifyIf referred, please mention their name:Terms & Conditions *By submitting this form, you acknowledge and agree to the following: I understand that by enrolling in this transformation program, I am committing to making necessary lifestyle and dietary changes as guided. I acknowledge that this is a wellness and lifestyle-based program, not a medical treatment. If I have any existing health conditions or concerns, I will consult a qualified medical professional before proceeding. I understand that if I choose to discontinue the program for any reason—whether personal or unavoidable—no refunds will be issued. Package Freeze Policy (Applicable to programs of 3 months and above only) I may request to freeze my program up to two times during its duration. Each freeze must be for a minimum of one week.I acknowledge that every individual’s body and lifestyle are different, and therefore results may vary from person to person. Submit