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Section 1 of 10
limited intake · 2026

your reset
starts here

live better, simply.

complete this intake form to apply for the lifestyle reset programme. be honest — your answers shape your entire plan.

32
questions
10
sections
~8
minutes
Section 01 / 10

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
Please select a dietary preference.
Section 02 / 10

baseline biometrics

* Resting Heart Rate (RHR)
3 readings/day for 3 days (9 total). Measure right after waking, no alarm.
Format: Day1: ___, ___, ___ / Day2: ___, ___, ___ / Day3: ___, ___, ___
Please enter your RHR readings.
* Resting Blood Pressure (RBP)
Morning & Evening for 2 days. Format: Day1 Morning: ___ / Evening: ___ | Day2 Morning: ___ / Evening: ___
Please enter your RBP readings.
Section 03 / 10

nutrition reality check

* 3-Day Diet Recall
Food, quantity & timing for the past 3 days. Be completely honest.
Please complete your 3-day diet recall.
Section 04 / 10

medical & supplementation

* Do you take any medications?
Please answer this question.
Supplements you currently use
Section 05 / 10

recovery & stress audit

Stress Level
Very LowExtremely High
Average Sleep Duration
Sleep Quality
Sleep Time
Wake-up Time
Section 06 / 10

activity & training profile

Occupation Type
Daily Steps (if tracked)
Training Experience
How many days per week do you currently work out?
Select the number of training days in a typical week.
Section 07 / 10

health flags

Do you have any injuries?
Any medical conditions?
Do you smoke?
Digestive Issues
Mental Stress / Burnout
Section 08 / 10

blood reports

Upload Blood Reports
CBC, Lipid Profile, KFT – recent reports preferred.
📋
Drop files here or browse
To share files with your coach, paste a Google Drive or WeTransfer link below.
Section 09 / 10

transformation intent

* What is your primary goal?
Please describe your primary goal.
* Why do you want this transformation now?
Please answer this question.
* Biggest challenge you've faced till now
Please describe your biggest challenge.
* What has NOT worked for you before?
Please answer this question.
Section 10 / 10

discipline checkpoint

Commitment Level
Not Committed100% All In
Are you ready to follow a structured system strictly?
✦

application submitted

you've taken the first step towards your lifestyle reset.

If selected, you'll be contacted with the next steps.

limited intake · 2026