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FREE Body Analysis
FREE Body Analysis
*Name
*Sex
Male
Female
Birthday (dd/mm/yy)
Occupation
*Height (cm)
*Weight (kg)
*Area of Resident
*If you need a phone consultation, kindly provide your contact phone number
E-mail
*Best Time to Call
Morning
Afternoon
Night
Anytime
*How did you gain weight? (Chose all that applies)
Born Fat
After delivery
Lack of exercise
Overeat
Snack/Junk food
Irregular meal time
Supple
Love sweet food
Love fried food
Aging
Medication
Taking birth control pill
Accumulate fat at certain body part
Others
*What weight loss method have you tried? (Chose all that applies)
Slimming pill
Diet/Starving
Replacement meal
Slimming tea
Exercise
Slimming center
Others
*How much weight do you want to lose?
Less than 5 kg
5 kg - 10 kg
10 kg - 15 kg
15 kg - 20 kg
More than 20 kg
*Health condition
Always smoke
High blood sugar
High blood pressure
Always drink
Always snack
Always take coffee
High uric acid
Menstrual pain/irregular
Constipation
Frequent back pain/joint pain
Gastric problem
Always sleep later than 12 midnight
None applies
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