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This data is essential for our Nutritionists  at Indiadiets.com to plan out your Personal Diet plan. Please fill up all the details correctly.  Assurance: We at Indiadiets.com assure you that this data will be kept completely confidential and will be utilized solely towards the personalisation of  your Diet Plan  PART I (A): PERSONAL INFORMATION Name: Age (years) years Sex: Male Female Height cms Weight in Kgs: kgs Marital Status: Married Unmarried Divorcee Widow Widower Occupation: Smoking: Yes No Occasionally Drinking Yes No Occasionally Do you Exercise? If yes, what type & how often: Food Allergy / Body Ailments / Medical History (if any) Food Habit Veg     Non-Veg    Semi-Veg Main meal Click here Breakfast Mid - morning Lunch Evening Dinner Peak hunger Click here Early morning Morning Mid morning Noon Evening Dinner time Bed time Which part of the day do you crave most for food Water intake Click here Less than 5 05 to 07 glasses 08 to 10 glasses 11 to 12 glasses 13 to 15 glasses More than 15 PART I (B): Approx. Present Meal Pattern (what you normally eat OR like to eat) Breakfast + Mid - morning Lunch Tea Dinner Milk Click here to choose No milk at all 1 glass (medium size) 1 glass (large size) 2 glasses (medium size) 2 glasses (large size) 3 glasses (medium size) 3 glasses (large size) 4 glasses & more (medium size) 4 glasses & more (large size) Address Country Click  here  to  choose Afghanistan Albania Algeria Andorra Angola Anguilla Antarctica Antigua/Barbud Argentina Armenia Aruba Ashmor/Cartier Australia Austria Azerhaijan Bahamas Bahrain Bangladesh Barbados Bassas d India Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia/Herzeg Botswana Bouvet Island Brazil British Iot British Vi Iss Brunei Bulgaria Burkina Burma Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central Afr R Chad Chile China Christmas Is Clipperton Is Cocos (Keelng) Colombia Comoros Congo Cook Islands Coral Sea Iss Costa Rica Cote d'ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Rep Ecuador Egypt El Salvador Equator Guinea Eritrea Estonia Ethiopia Europa Island Falkland Iss Faroe Islands Fiji Finland France French Guiana French Polynes French So/Ant Gabon Gambia Gaza Strip Georgia Germany Ghana Gibraltar Glorioso Iss Greece Greenland Grenada Guadeloupe Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard/Mcdon Is Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Iraq-Saudi Ara Ireland Israel Italy Jamaica Jan Mayen Japan Jersey Jordan Juan de Nova I Kazakhstan Kenya Kiribati Korea Peo Rep Korea Rep of Kuwait Kyrgyzstan Laos Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Man Isle of Martinique Mauritania Mauritius Mayotte Mexico Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Namibia Nauru Nepal Netherlands Netherlands An New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Is Norway Not stated Oman Pakistan Panama Papua N Guinea Paracel Iss Paraguay Peru Philippines Pitcairn Iss Poland Portugal Qatar Reunion Romania Russia Rwanda San Marino Sao Tome/Princ Saudi Arabia Serbia Seychelles Sierra Leone Singapore Slovakia Slovania Solomon Iss Somalia South Africa Spain Spratley Iss Sri Lanka St Helena St Kitts/Nevis St Lucia St Pierre/Miqu St Vincent/Grn Sudan Suriname Svalbard Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania U Rep Thailand Togo Tokelau Tonga Trinidad/Toba Tromelin Is Tunisia Turkey Turkmenistan Turks/Caicos I Tuvalu Uganda Ukraine United Arab Em United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wallis/Futuna Western Bank Western Sahara Western Samoa Yemen Yugoslavia Zaire Zambia Zimbabwe Tele No: Email

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