simple lifestyle application form

limited intake · 2026

live simply. thrive naturally.

your 90 day
lifestyle reset

honest intake. personalised programme. 90 days that change how you live — not just how you look.

5sections

90days

~8minutes

Section 01 / 05

identity & body metrics

* Full Name

Please enter your full name.

* Mobile Number

Please enter a valid 10-digit mobile number.

* Email Address

Please enter a valid email address.

* Age

Please select your age.

* Height (cm)

Please enter your height in cm.

* Weight (kg)

Please enter your weight in kg.

* Dietary Preference

Vegetarian Non-Vegetarian Eggetarian

Please select a dietary preference.

Section 02 / 05

health & medical

Do you have injuries or chronic pain?

Yes No

Describe your injury or pain

Location, severity and how long you've had it.

Do you drink alcohol?

Never Occasional Weekly Daily

Do you smoke?

Non-smoker Occasional Regular Ex-smoker

Do you take any medications?

Yes No

List your medications

Include name, dosage and frequency.

Any medical conditions?

Thyroid Diabetes High BP PCOS / PCOD Heart condition None Others

Digestive Issues

None Bloating Acidity Irregular

Section 03 / 05

recovery & stress

Stress Level

Very LowExtremely High

Average Sleep Duration

Sleep Quality

Deep & Restful Moderate Disturbed Frequently waking

Approximate Sleep Time & Wake-up Time

Sleep time

Wake-up time

Section 04 / 05

activity & training

Occupation Type

Sedentary (desk job) Moderately active Highly active (on feet most of day)

Daily Steps (if tracked)

Training Experience

* How many days per week do you currently work out?

0 1 2 3 4 5 6 7

Please select how many days you work out.

Section 05 / 05

goals & commitment

* What are your primary goals?

Select all that apply.

Healthy Lifestyle Fat Loss Muscle Gain Stamina Building Better Sleep & Recovery Stress Management Others

Please select at least one goal.

* Biggest challenge you've faced so far

Select all that apply — be honest.

Consistency Cravings Poor Sleep Stress Time Management Lack of Motivation Others

Please select at least one challenge.

Commitment Level

Not committed100% all in

Are you ready to follow a structured system strictly for 90 days?

Yes No Need to understand more first

✦

application submitted

you've taken the first step towards your 90 day reset.

if selected, you'll be contacted within 48 hours with next steps.