Pnut
First Name: *



Email: *



Phone (without 0 or +91): *



City: *



Locality:


Age: *



Gender:
Male Female

My weight is around (Kgs):


My Height is around (Feet): *



(inches): *



Body FAT % (Refer to the chart): *



Plan of action: *



Please elaborate on your fitness goal: *



What is keeping you from achieving your fitness goals?: *
Lack of Motivation Self-Consciousness Lack of Time Hitting a Plateau Not Knowing Where/How to Begin Lack of Results


Select your daily level of physical activity: *



What motivates you?:


How often do you eat?:
6 or More Times a Day (controlled) 3- 4 Times a Day Whenever Hungry 5- 6 Times a Day (controlled) Strictly Breakfast, Lunch, and Dinner Less Than 2 Times a Day

Are you allergic to any of the following:
Peanuts Tree Nuts Milk Shellfish Eggs Wheat Soy Fish

Are you currently on any special diet? If yes, please elaborate:


Please select if you have any of the following medical conditions:
Diabetes Type 1 Diabetes Type 2 PCOD Hypertension Blood Pressure Issues Insomnia Thyroid Issues Hormonal Imbalances

If you have selected others, please elaborate your medical here:


Do you take any vitamins, minerals, or supplements? If yes, please elaborate:


List your top 3 nutrition questions or concerns:


Tobacco Use:


Alcohol Use:


I authorize PNUT to send information on my email / mobile phone. : *



I accept the terms and conditions.: *