Weight Loss Plan

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Your information is private and will only be used by 120 Fruit Therapy experts to understand your body goals, preferences, and health background so we can recommend the best plan for you.
We do not share or sell your information to anyone. All responses are handled confidentially and used only to help you achieve your desired results safely.

Weight Loss Plan Form

Please fill out this comprehensive form to help us create your personalized weight loss plan.

Personal & Demographic Details

Full Name *

Age *

Gender *

Height in cm *

Current Weight in kg *

Target Weight in kg *

Occupation

Location for Delivery *

Health Background

Known Allergies

Medical Conditions

Medications or Supplements

Frequency of Sickness / Fatigue

Family History (Metabolic/Hormonal Issues)

Lifestyle & Routine

Number of Meals Per Day

Time of First Meal

Time of Last Meal

Do You Skip Meals?

Hours of Sleep Per Day

Level of Physical Activity

Do You Exercise or Work Out?

Water Intake in Liters Per Day

Alcohol or Smoking Frequency

Food Preferences & Taste

Fruits You Enjoy

Fruits / Flavors You Dislike

Preference: Creamy vs Lighter

Sweetness Level Preference

Open to New Ingredients?

Preferred Eating Time (Smoothies/Salads)

Goals & Motivation

Main Reason for Wanting to Lose Weight

Past Challenges Faced

Willingness to Make Lifestyle Changes?

Plan

Optional Lifestyle Check

Frequency of Stress / Anxiety

Do You Eat Fruits Regularly Outside This Plan?

Movement / Activity During the Day

Morning Sun Exposure / Indoor Time