1Balance | Metabolic Health Assessment

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Basic information* This field is required
Your name

Select your gender

To calculate your BMR

Select your age

To calculate your BMR

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To calculate your BMR

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7' 8"

7' 9"

7' 10"

8' 0"

To calculate your BMR
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3

Body Type* This field is required

Ectomorph (thin, wiry build)

Mesomorph (medium, muscular build)

Endomorph (wide, heavy build)

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4

Activity Level* This field is required

Sedentary (Little to no exercise, desk job)

Lightly active (light exercise/ sports 1-3 days/week)

Moderately Active (moderate exercise/ sports 6-7 days a week)

Very Active (hard exercise every day, or exercising 2 xs/ day)

Extra active (hard exercise 2 or more times per day, or training for marathon, or triathlon, etc.)

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5

Dietary Preferences* This field is requiredSelect all that you eat as part of your regular weekly diet

Plant-based Foods

Eggs

Poultry

Red Meat

Dairy

Seafood

Mushrooms

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6

AllergiesSelect all that apply

Dairy (Lactose)

Eggs

Wheat (gluten)

Peanuts

Tree Nuts

Fish

Shellfish

Soy

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7

Any known medical issues?

Hypertension

Diabetes

Asthma

Cholesterol

Allergies

Kidney Stones

Ulcers

Arthritis

Insomnia

Hairfall

Stress

Anxiety

Depression

Fatigue

Migraine

Hyperthyroidism

Hypothyroidism

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8

Your skin is?* This field is required

Dry, rough; Sensitive to cold; Cold to touch

Dry and oily in patches; Sensitive to heat, light and chemicals; Warm to touch

Supple and oily; Cool to touch

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9

In terms of Appetite, you feel* This field is required

Mildly hungry often; Full quickly; Mild discomfort when you skip a meal

Strong hunger pangs at regular meal times; Irritated if a meal is skipped; Strong thirst

A slow, consistent build up of hunger; almost no discomfort when you skip a meal

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10

When your digestion is out of whack, you have a tendency towards* This field is required

Constipation, bloating, gas

Acidity, heartburn, diarrhoea

Excess mucus in stools, feeling of incomplete elimination

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11

Your sleep is* This field is required

Light; easily interrupted; 5-6 hours sufficient

Uninterrupted; 6-7 hours sufficient

Sound and prolonged sleep; 7-8 hours required

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12

You are* This field is required

Very active, fidgety

Purposefully active

Mostly sedentary

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13

As per your friends and colleagues, you are someone who can* This field is required

Quickly come up with lots of ideas and think out-of-the-box

Find the fastest solution to tricky problems

Easily connect the dots and understand the big-picture

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14

Your friends feel that you are* This field is required

Moody

Passionate

Calm

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15

Digestion* This field is requiredI have a good appetite at meal times and my digestion is great

Once in a blue moon

Every other day

On most days

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16

Sleep* This field is requiredI sleep well and feel rested in the morning

Very rarely

Few days in a week

On most days

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17

Stamina/ Energy* This field is requiredI feel light and energetic

Till about mid day

Till Evening

Right through the day

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18

Immune Function* This field is requiredThe last time I fell sick was

Less than a month ago

A few months ago

Can't remember the last time I fell sick

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19

Physical Health* This field is requiredI feel aches and pains in my joints

Pretty much every day

Every once in a while, on stressful days

Only if I injure myself

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20

Mental Health* This field is requiredThe last time I felt stressed out, anxious or depressed was

Less than a month ago

A few months ago

So long back, I cant remember when

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21

Email

[email protected]

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22

Contact Number (optional)We will send you important information and updates via SMS

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23

Enter Your Email* This field is requiredSo that we can send you the complete report

[email protected]

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