Weight loss membership form, Indianutrition: Your guide to Health, Nutrition, Diets, Fitness, Weight loss, Diet counselling, customized diets

Indianutrition Health Perfect (IHP): The weight loss programs

Membership Form

This data is essential for our Nutritionists at Indianutrition.com to plan out your personal Diet plan. Please fill up all the details correctly.

Assurance: We at Indianutrition.com assure you that this data will be kept completely confidential and will be utilized solely towards the personalization of your Weight Reduction/Gain Programs

PERSONAL INFORMATION

Name in full:

Program		Duration (weeks)	Maintenance (months)	Charges
	A	5	1	US $ 95 (Indian Rs. 4370 /-)
	B	10	2	US $ 150 (Indian Rs. 6900 /-)
	C	15	3	US $ 205 (Indian Rs. 9430 /-)
	D	20	4	US $ 260 (Indian Rs. 11960 /-)
	S*	--	--	US $ 20 (Indian Rs. 920 /-)

S*:- Indianutrition Special Offer [Program S]: Only for those who wish to maintain their already perfect figure / physique and good health by inculcating proper food habits and dietary regulations. For details

Maintenance is a part of the individual program, with no extra charges

The prices are inclusive of Postal / Courier charges for sending the IHP Diet Package

Referral:

Sex:

Male

Female

Age:

Height:

Weight:

Occupation:

Marital Status:

Problem areas of fat distribution / Max. fat is located on: (mark applicable areas if any else leave blank)

	Chest		Thighs
	Upper Abdomen		Calves & Ankles
	Lower Abdomen		All Over
	Hips

Smoking:

Yes

Occasionally

Drinking:

Yes

Occasionally

Do you exercise?
If yes, what type & how often:

Food Allergy /
Body Ailments /
Medical History (if any)

History of Obesity:

(Optional)

Food Habit:

Veg

Non-Veg

Occ. NV.

Eating Speed:

Slow

Normal

Fast

Main Meal:

Peak Hunger:

(Which part of the day do you crave most for food)

Water intake:

Approx. Present Meal Pattern (Based on what you normally eat or like to eat)

Breakfast +
Mid Morn:

Lunch:

Tea:

Dinner:

Milk:(per day)

Address (optional)

Country

Telephone No:

E-Mail:

Read this membership form and if you agree proceed on to click the "Submit" button to enroll in the program.

ABOUT THE PROGRAM

As you enroll for the Indianutrition Health Perfect (IHP) Diet Program / Maintenance Program a few guidelines are expected to be followed by you. This will certainly enable achievement of the results that you so dearly wish to attain.

IHP Diet Program is based on the principle of creation of a Negative Calorie Balance in the body  to attain target weight. This means that the body must utilise its storehouse of energy that has been stored in the form of fat. This fat reserve can be used to provide energy when INPUT (calorie /consumption) is less than OUTPUT (calorie used for body functions). And that is how the body loses fat. This is achieved by a combination of foods and Ayurvedic and Homeopathic medicines.

1. ANALYSING EXCESS WEIGHT

On joining the IHP Diet Program, a detailed analysis is made of the energy that you are utilising to attain target weight through the following steps.

1.1 	The Lifestyle & Habit Analysis:- is a comprehensive personal analysis of the members lifestyle, food habits and energy expenditure (in the form of exercise and other activities), to ascertain the excess weight and attain target weight.

1.2	Medical Examination Feedback (not necessary for online Program) :- involves feedback on blood pressure, pulse rate alongwith other associated data and is done (if required) in order to evaluate the specific weight loss a member requires and to avoid any side effects.

1.3	Input Analysis :- consists of determining the daily nutritional and calorie inputs required to be taken by a member. Input recommendations are made by suggesting a combination of nutritionally adequate foods alongwith Ayurvedic formulations to ensure a healthy and effective way to achieve the target weight.

2. PROGRAM GUIDELINES

2.1	Each program (IHP Weight Loss Program / IHP Maintenance Program) will independently deliver results. Success would depend on the complete adherence to the program guidelines.

2.2	Contact through Email will be maintained throughout the course of the respective Program. Weekly / Fortnightly / Monthly progress will be asked for from the individual undergoing the Program. Ayurvedic formulation for the package will be delivered through post. Overseas charges extra.

2.3	Members will testify that they are medically fit to go on the programme. Indianutrition.com is not responsible for medical complications not revealed prior to commencing the programme.

2.4	Each member on the diet plan needs to undergo a Lifestyle and Habit Analysis, Medical Examination Feedback and Input Analysis to attain target weight.

2.5	The IHP Diet  Programs provide the user a way of losing weight effectively by the creation of the Negative Calorie Balance, Combination Of Foods, and Ayurvedic formulations.

2.6	Each member needs to understand the principle of Negative Calorie Balance which is achieved by decreasing calorific inputs and increasing calorific expenditure, while ensuring nutritional adequacy.

2.7	Consumption of IHP recommended diets and foods during the program are essential to maintain nutritional adequacy.

2.8	The program does not involve the use of any drugs, surgery, liposuction, body wrap or deep heat which are considered harmful in the long run.

2.9	Indianutrition.com reserves the right to alter / change / substitute the program contents.

2.10	In case the member fails to achieve the desired target weight loss, it is because of insufficient creation of the Negative Calorie Balance due to deviations from the program guidelines by the member.

2.11	Indianutrition.com will retain the members photograph if taken, for record purposes only. Such photographs will not be used for publicity/promotion activities without explicit written consent of the member.

3. GUIDELINES FOR THE MAINTENANCE PROGRAM

3.1	Membership to Maintenance Program for the IHP members automatically commences on successful completion of the IHP Diet Program so as to ensure maintainance of the results.

3.2	The Maintenance Program is on a 1/2/3/4 months basis as per the IHP Diet Program undergone.

3.3	Members will be given Food Guidelines for a Maintenance Food Plan as per the Counsellor's advice.

3.4	Indianutrition.com will not be liable/responsible if any of the program guidelines are not adhered to and the member does not attain the target weight.

3.5	Members will be explained about the Physiological Plateau that occurs when the body has been steadily losing weight. It is found that a Stabilization Phase is needed as the body conditions itself to lesser weight. A member, on the Maintainance Program, thus learns the value of understanding his/her body & its ideal weight and how to reach towards that ideal goal. IHP helps and aids the members in reaching this goal by introducing breaks by which the body stabilises and then begins another phase of fat loss. This is how the target weight is achieved and maintained in a natural, scientific and personalised program designed to help members maintain their weight with proper counselling  and nutritional advice.

4. TERMS AND CONDITIONS

4.1   Non-Refundable and Non-Transferable membership charges (as give above) will be payable to enroll for the IHP Weight Loss Programs. These charges include the fees for Maintainance period as well.

4.2	 Membership will be valid till the end of the Maintainance period from the date of start of Program/date of enrollment.

4.3	 Indianutrition.com reserves the right to change the membership fee structure and prices of IHP Programs /  Services from time to time and the members are bound by the same.

5. DECLARATION

5.1 	I have read and understood the Membership Application Form and I accept and agree to what is stated therein.

5.2	I have understood the programme and Terms and Conditions of the Membership.

5.3	I have decided to participate in the program after being fully satisfied with all aspects of the programme and out of my own free will.

5.4	I will not hold Indianutrition.com liable / responsible in any way for any injury / damage / illness that I may suffer during or after the program.

In case of any doubts / clarifications please mail dietcounsellor@indianutrition.com

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