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Personalized Diet Counseling form

These details are required to sum up your Diet Counseling needs and to know your individual requirements and queries. An analysis shall then be done by our Experts and accordingly the most appropriate advice cum Personalized Diet Counseling shall be rendered to you through e-mail.

(If you live in Delhi / New Delhi / Noida / Gurgaon, and wish to avail a Diet Counseling session in person, you can fix up an appointment by emailing dietcounsellor@indiadiets.com)

Assurance: We at Indiadiets.com assure you that this data will be kept completely confidential and will be utilized solely towards the personalization of  your Diet Counseling mail 

Please Fill the form below and we will get back to you soon..

Name 
Age
years Sex Male Female
Weight
kgs Marital Status  

Occupation
 Height    
Smoking
Drinking  
If you exercise, how often  (optional)
What type of Exercise  (optional)
Any ailment / medical history
Your counseling requirement (in detail)
Any other information you may like to bring out 
Address
Country
Telephone No:
E-mail
   
 
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