30-Day Shift Eligibility Form | Yogalates for Her

Full Name*

Phone Number*

Age*

What best describes your current concern?*

Hormonal weight gain

Stress-related weight gain

Belly fat that won’t reduce

Weight gain after pregnancy

Bloating / inflammation

Low energy / fatigue

How long have you been trying to lose weight?*

Less than 6 months

6–12 months

1–2 years

More than 2 years

Have you tried any of the following before?*

Diet plans

Intermittent fasting

Gym / cardio programs

Home workouts

Online coaching

None / just starting

Do you experience high stress or anxiety regularly?*

Yes

Sometimes

No

Do you experience emotional or stress eating?*

Yes

Sometimes

No

Have you been diagnosed with any of the following?*

PCOS / PCOD

Thyroid issues

Insulin resistance

Other

If you selected 'Other' in the above question then please specify

Are you willing to follow daily guidance for 30 days?*

Yes

Not sure yet

What are you hoping to feel after 30 days?

How would you like to join the program?*

Offline (₹9,999)

Online (₹7,999)

Consent & Disclaimer*

I understand this is a lifestyle & movement-based program, not medical treatment.

*

I confirm that I am participating voluntarily and will consult a doctor if needed.

Check Your Eligibility for

The 30-Day Shift