Dr.

Shikha Singh Tran

PLEASE FILL ALL THE DETAILS MENTI
1 Name
2 Age/Sex
3 Contact Number/Mail I.D
4 Current Country , State , City of residence
5 Nationality
6 Profession
7 Father's / Husband's Profession
8 Father's / Husband's Name
9 Height
10 Weight
11 Constipation (Yes/No)
12 Thyroid (Hypo/Hyper/None)
13 PCOD (Yes/No)
14 Blood Pressure :- High/Low/Normal
15 Sugar/diabetes/Prediabetes (Yes/No)
16 Acidity (Yes/No)
17 Any Other Medical History
18 Any Medication Current Or Past (Mention)
19 Any Surgery In Past (Mention)
20 Blood group
21 Any Food Allergy
22 Working Hours
23 Wake Up time:-
24 Motion/Bowel Movement in the morning(yes/no)
25 Breakfast time:-
26 What Do You Eat In Breakfast
27 What Do You Eat In Mid Morning:-
28 Lunch time:-
29 What Do You Eat In Lunch

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30 Evening Tea time:-
31 What Do Have With Evening tea
32 Dinner time:-
33 What Do You Eat In Dinner
34 Favorite junk Food
35 How Much Water Do You Drink In A Day
36 Periods date
37 Periods Regular/Irregular
38 Genetic ailment or disease
39 Sleeping Time & Sleeping hours
40 Family members
41 Married/ unmarried
42 Kids
43 Stress (High/Low)
44 How much weight do you want to lose
45 Reason for weight loss
46 Are You Vegetarian /Non-Vegetarian

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gh Transformations
HE DETAILS MENTIONED BELOW :-

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