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Diet Plan Questionnaire Form

Your Name

Personal Details

1. Your Mobile Number
2. Your Gender
3. Your Age
4. Your Weight
5. Your Email Address

How many meals do you take Per Day on Average


What do u take for BreakFast


What time do you take your breakfast


What do u take for Lunch


What time do you take your Lunch


What do u take for Dinner


What time do you take your Dinner


How Often do take Junk Per Week


How Often Do u take Soft Drinks Per Week


Are you Allergic to any Foods..Kindly List them Below

16. What did you take on Monday.Fill in the Spaces Provided
17. What did you take on Tuesday.Fill in the Spaces Provided
18. What did you take on Wednesday.Fill in the Spaces Provided
19. What did you take on Thursday.Fill in the Spaces Provided
20. What did you take on Friday.Fill in the Spaces Provided
21. Do You WorkOut
22. What Kind of Workout

Workout Schedule

23. Monday WorkOut
24. Tuesday Workout
25. Wednesday Workout
26. Thursday Workout
27. Friday WorkOut

Payment Details

Diet Plan Program Ksh 500

Gym Workout Plan Ksh 600

Home WorkOut Plan Ksh 400

Diet Plan+Workout Plan Ksh 800



Lipa na M-PESA

Till Number 782 865

Skrill Email  njawatech@gmail (dot) com