Name
Gender
Male
Female
Age
Years
Email Address
Country
Occupation
Business
Service
Self Employed
Teacher
Fitness Expert
Lawyer
Clerical
Medical
Unemployed
Housewife
Student
Other
Select One
Nature of Work
Select One
Active
Hardwork
Sedentary
Stressful
Personal Details
Weight
in Kg.
in lbs.
Blood Pressure
Hart Pulse
Per Min.
Appetite
Normal
Good
Poor
Non-Satisfactory
Sleep
Normal
Sound Sleep
Inadequate
Disturbed
Non-Satisfactory
Addiction
Non
Over Eating
Smoking
Alcohol
Sleeping Pill
Drugs
Marital Status
Single
Married
Divorced
Widow
Menstrual Details
(for ladies)
Present complaints and Treatment taking
