Intake form

Help us serve you better

Name *

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What are your primary health goals?

Please select at least one option.

Weight loss

Muscle gain

Improving energy levels

Better digestion

Managing a health condition

Improving overall health

Do you have any dietary restrictions or allergies?

What is your current level of physical activity?

Please specify any health conditions you have (e.g., diabetes, hypertension):

How would you describe your current eating habits?

What is your age?

What is your gender?

What is your height (in cm)?

What is your weight (in kg)?

How did you hear about NutriWise?

Additional questions or comments

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