Online nutrition coaching registration form
Please fill in the form below to register for your Online Nutrition Coaching.
*mandatory fields.
關於我
名字
*
此欄位必須填寫
姓氏
*
此欄位必須填寫
我是PURE持卡人
*
是
否
此欄位必須填寫
會員號碼
*
此欄位必須填寫
手機號碼
*
此欄位必須填寫
電郵
*
此欄位必須填寫
Date of Birth
*
此欄位必須填寫
Current weight (kg)
*
此欄位必須填寫
Height (cm)
*
此欄位必須填寫
Location and time zone
*
此欄位必須填寫
Occupation and work/shift pattern
*
此欄位必須填寫
Preferred time for consultation
*
Morning
Afternoon
Evening
此欄位必須填寫
Please rank your goals in order of importance (Fat loss/Muscle retention/Improved energy/General health/Education)
*
此欄位必須填寫
Which gender would you prefer your nutritionist/dietitian to be?
*
Male
Female
No preference
此欄位必須填寫
Please pick preferred language of coaching (note: all support material is in English):
*
Mandarin
Cantonese
English
此欄位必須填寫
Any other important information that you would like to provide for your Online Nutrition Coaching?
*
此欄位必須填寫
提交