Contact Shanthi Kasiraj | Fitness Coach & Nutritionist for Women

Full Name is required.

Mobile Number is required.

Occupation is required

Preferred Time *

Morning 5:30 - 6:30 Evening 5 - 6

Please select your preferred time.

Enrolling For *

Both (Rs. 5900 one time + Rs. 2360 monthly)

Please select an option.

The timings when you eat along with the quantity *

Meal time is required.

Water Intake (Per Day) *

1.5 L 2 L 3 L 4 L

Please select a water intake per day.

Sleep duration is required.

Bed time is required.

Wakeup time is required.

COOKING MEDIUM (CHOICE OF DIETARY FATS) *

Butter / Ghee Coconut Oil Sunflower Oil Soyabean Oil Corn Oil Others

Food Preference *

Veg Non-Veg Vegan Others

Please select an option.

Dietary Restrictions *

Dietary Restriction is required.

Health Reasons *

Health Reason is required.

High Dislike Towards *

High Dislike Toward is required.

Supplements Usage *

No MULTI VITAMIN VITAMIN C & VITAMIN E FISH OIL CALCIUM / MAGNESIUM / VITAMIN K2 / VITAMIN D3 WHEY PROTEIN

Disclaimer: You agree that all the information provided by you is accurate. We don't provide medical aid for any disease nor do we claim to be doctors. This is not a clinical nutrition assistance program, it is intended only for people who do not have any disease and want to lead a healthier life. *

I Agree (Information Accuracy) *

You must agree to the information accuracy to proceed.

Common sense is your best guide when you answer these questions. Please read the questions carefully and answer each one Honestly. *

I agree to answer honestly *

Please confirm your honesty to proceed.

Has your doctor ever said that you have a heart condition and that you should only do physical activity / exercise recommended by a doctor? *
Yes No

Please select an option.

Is there any history of heart disease in your family? *

Yes No

Please select an option.

Do you feel pain in your chest when you do physical activity / exercise? *

Yes No

Please select an option.

In the past month, Have you had chest pain when you were not doing physical activity / exercise? *

Yes No

Please select an option.

Do you lose your balance because of dizziness or do you ever lose consciousness, while exercising? *

Yes No

Please select an option.

Do you have a bone or joint problem ( for example, Back, Knee, & Hip ) that could be made worse by a change in your physical activity? *

Yes No

Please select an option.

Do you suffer from any of the following: Asthma, Diabetes, Epilepsy, High blood pressure etc. because of which your doctor recommended you to not do exercise? *

Yes No

Please select an option.

Do you have any other medical or physical condition which may be worsened by physical activity? *

Yes No

Please select an option.

Do you have any current injuries or conditions? *

Yes No

Please select an option.

If you answered YES to any of the questions above, please check with a doctor once to get clearance to do physical activity. *

I agree to consult my doctor if required

You must agree to consult your doctor for safety reasons.

Terms and Conditions - Disclaimer - Any exercise program, even in healthy individuals, carries risk. You have a responsibility to exercise your own personal judgment, so, you agree that you are voluntarily participating in this physical training. By filling this form, you agree that all the details provided by you are accurate and true. Payment: Clients are required to pay the specified fees for the services provided by KSR Wellness and Digital in advance of receiving any services. Non-Refundable Fees: All fees paid to KSR WELLNESS AND DIGITAL are non-refundable unless otherwise stated in writing by us. This includes but is not limited to consultation fees and training fees. Transfer of Fees: Fees paid to KSR WELLNESS AND DIGITAL are non-transferable between clients, programs, or services unless explicitly agreed upon in writing by us. *

I agree

Please read and accept the Terms & Conditions to proceed.

Have Any Questions?

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Have Any Questions?

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