What's your name?
Let's get to know each other before we
dive into the quiz.
Full Name
Phone Number
*
Email
*
How often do you consume Vegetables/Fruits?
Never
1x Week
2-3x Week
Daily
How often do you consume Soft Drinks?
Never
1x Week
2-3x Week
Daily
How often do you consume Packaged Foods (Maggi, Digestive Cookies)?
Never
1x Week
2-3 Week
Daily
How often do you order food online?
Never
1x Week
2-3x Week
Daily
How often do you consume Fast Food (Samosa, Noodles, Burger, Momos)?
Never
1x Week
2-3x Week
Daily
How often do you consume Tea/Coffee (200ml)?
Never
1x Week
2-3 Week
Daily
You are thirsty, you will choose?
Water
Tea/Coffee
Soft Drink
Juice Box
What is your daily water intake?
1-4 Glasses
5-8 Glasses
8-12 Glasses
>12 Glasses
Do you read the ingredients on everything you consume?
Yes
Sometimes
No
Don't Care
How much sugar do you consume in a typical day?
0-2 Tbsp (1 Tbsp - 15gm)
2-3 Tbsp
>3 Tbsp
Sugar Free/Subsitute
Do you exercise?
2 Times a Week
3-4 Times a Week
No
5 or More times a Week
Which of these do you prefer?
Running/Yoga
Strength Training
Cardio
Don't Exercise
How is your general day like?
Sedentary (No movement)
Somewhat Active (Example Household chores etc.)
Very Active (Example - On feet at work)
Are you stressed?
Yes, all the time
Sometimes
It comes and goes, no worries.
No, not really
How much sleep do you get?
4-5 hours
6-7 hours
8-10 hours
<4 hours
Do you smoke?
Yes
No
I quit
Do you consume alcohol?
Yes
No
Socially
When you start feeling unwell like a cold, you
Take home remedy
Take a medicine
Call the doctor
Ignore it
Do you use any of the following in your kitchen?
Plastic Storage Boxes
Teflon Coating Cookware
Aluminium Foil
None of these
How frequently do you fall sick?
Once a week
Once a month
Once in few months
Once in a year
Do you have any of the following disease?
Diabetes/PCOD/Thyroid/Hypertension
IBS/Constipation/Fatty Liver
Arthiritis/Osteoperosis
No
Have you lost weight earlier?
Gained & Lost Several Times
Gained and Lost Once
Gained weight for the First Time
Do you feel low in energy or are often fatigued?
Never
Rarely
Occasionaly
Often