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Online Diet Plan

HomeOnline Diet Plan

Home
Blog
About Us
Online Diet Plan
Shop
Contact Us

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Online Diet Plan

Please fill the form below and give the proof of payment. Once you submit the information please wait for 24 to 48 hours for the diet plan to be sent to you. Please note payment are as following:

First Diet PlanRs 2000/- ONLYFOR THE FOLLOW UP DIET PLAN RS : 1300 /- ONLY

ACCOUNT DETAILS

BANK NAME : MCB Bank Limited

ACCOUNT TITLE : MUHAMMAD YOUNIS

ACCOUNT NUMBER : 1158594081009829

IBAN: PK54MUCB1158594081009829

Please fill out the form below

Name

Phone

Email Address

You got to know about us from ?

Gender

Weight (kg)

Height (Ft)

Age

Occupation

Martial Status

Select your Goal

How would you consider yourself?

Are you allergic to any of the following foods? Please select all that apply.PeanutsTreenutsSesameDairy ProductsShellfishFishEggsWheat / GlutenSoyaCeleryMustardOthers

Do you have Children ? (If yes mention their age)

Do you smoke?

List all the medications, Vitamins, Minerals, or any Dietary supplements you are using below

Please Indicate whether you have been diagnosed with any of the following disease or symptomsAnemiaAnxiety or panic attackArthritis (osteoarthritis or rheumatoid)AsthmaBronchitisCancerChronic fatigue syndromeDiabetes type 1Diabetes type 2PrediabetesGastrointestinal diabetesEczemaEpilepsyFibromyalgiaFungal infectionsGoutHeart AttackHeart DiseaseHepatitisHigh blood fats( cholesterol, triglycerides)High blood pressure (Hypertension)Hypoglycemia ( low blood sugar)Others

Please select the physical activities you are involved often

How often you skip your meals?

How many days per week do you eat Breakfast? Lunch? Dinner?

Do you snack ? ( If yes when and what)

Do you buy or pack your launches? ( Please mention number of days per week)

Are you currently on a diet or taking medications to lose weight or to maintain your current weight? (If yes please describe below)

Do you eat out? ( If yes, how many days per week)

What type of restaurants you usually choose

Who usually prepare the food at home?

Who does the grocery shopping?

How many pieces of fruits do you eat each day and how many glasses of fruit juice daily?

On average, how many servings of vegetable do you eat each day?

On average, how many times a week do you eat eat a high-fibte breakfast cereal?

How many times a week do you eat red meat (beef, Mutton)?

How many times a week do you eat chicken?

How many times do you eat fish?

What is portion size of meat/chicken/fish do you eat?

How many hours of television do you watch each day?

How many times a week do you drink soft-drinks?

Which type of milk do you drink ? (While milk or low-fat milk or skim milk)

Do you eat snacks while watching television?

How many times a week do you eat desserts or sweets?

How many glasses of water do you drink each day?

How many glasses of milk do you drink daily?

How often do you usually consume dairy products, and which type?

How many cups of tea/coffee do you take each day?

How many times a week do you eat rice and what is the the usual portion size?

How many tablespoons of butter/margarine/ghee do you consume each day?

How much sugar and milk do you add in your tea?

Do you consider yourself?

Sleep time you normally go to bed ? Wake up time?

How many hours of sleep do you need to feel rested?

What did you eat and drink yesterday? Please include portion sizes and brands if it possible i.e 1 cup of orange juice, 6 ounces non fat yogurt, etc ( please mention breakfast, lunch,and dinner and in between snacks along with timings)

Any exercise you do? Time you spend doing that and number of day you do per week?

Any other information you would like to share with dietitian Younis please share so that diet plan can be prepared accordingly.

Upload Payment Proof (Screenshot) *Account Details is Provided at the start of this form

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