🧬 Personal Information

Full Name *

Age *

Gender *
MaleFemaleOther

City / Location *

Email Address *

WhatsApp Number *

📏 Body Stats

Height (cm) *

Current Weight (kg) *

Goal Weight (kg) *

Waist Circumference (cm) — optional

Daily Step Count (approx) *
Less than 3,0003,000–6,0006,000–10,000More than 10,000

🎯 Goals & Timeline

Primary Goal *
Fat LossMuscle GainWeight MaintenanceGeneral Health & EnergyManage a Health Condition

Target Timeline *
4 weeks8 weeks3 months6 monthsOngoing

🏃 Activity & Lifestyle

Activity Level *
Sedentary (desk job, no exercise)Lightly active (1–2 days/week)Moderately active (3–4 days/week)Very active (5+ days/week)

Work Type *
Desk / OfficeField / On-feetNight ShiftWork from HomeStudent

Training Style (if any)
Weight TrainingCardio / RunningYoga / PilatesCrossFit / HIITSportsNo Exercise Currently

Wake Up Time *

Sleep Time *

🍽️ Food Preferences

Diet Type *
Pure VegetarianEggetarian (Veg + Eggs)Non-VegetarianVegan

Cuisine Preference *
North IndianSouth IndianMaharashtrianContinental / WesternPan-AsianNo Preference

Foods You Dislike / Won't Eat

Food Allergies or Intolerances
Lactose IntolerantGluten IntolerantNut AllergyShellfish AllergyNone

How often do you eat out per week? *
Rarely (0–1 times)Sometimes (2–3 times)Often (4–5 times)Almost daily

Do you cook at home? *
Yes, dailyYes, sometimesRarelyNo, someone cooks for me

💊 Health & Medical

Any Medical Conditions? (select all that apply)
Type 2 DiabetesThyroid (Hypo/Hyper)PCOS / PCODHypertensionHigh CholesterolFatty LiverIBS / Digestive IssuesNone of the above

Are you on any medications?
YesNo

If yes, please mention your medications (optional)

💰 Budget

Monthly Food Budget (approx) *
Under ₹3,000₹3,000–₹6,000₹6,000–₹10,000₹10,000+

Monthly Supplement Budget (approx) *
Not interested in supplementsUnder ₹1,000₹1,000–₹2,500₹2,500–₹5,000₹5,000+

Which plan are you interested in? *
Basic – ₹499 (7-day AI plan + grocery list)Standard – ₹1,499 (plan + 1 video call + habit guide)Premium – ₹4,999 (monthly support + 2 calls + WhatsApp check-ins)

📋 Consent & Submission

I consent to Protein Hub Nutrition storing and processing my health data to generate my personalised diet plan. I understand this data will not be shared with third parties. (Required per India's DPDP Act 2023) *

I agree to receive my diet plan and follow-up messages on WhatsApp.