Diet Checker Form

Personal Information Name: Age: Gender: Weight (kg): Height (cm): Phone Number: Email Id:

Lifestyle & Activity Activity Level: Do you smoke? Yes No Do you consume alcohol? Yes No

Dietary Preferences & Allergies Diet Type: Allergies (check all that apply):

Meals

Meal	Food Options	Calories
Breakfast	Oats Eggs Milk Banana Bread	150 / 70 / 120 / 90 / 80
Lunch	Rice Chicken Vegetables Dal Salad	200 / 250 / 100 / 180 / 80
Dinner	Soup Fish Chapati Paneer Fruits	150 / 220 / 120 / 190 / 90
Snacks	Fruit Nuts Biscuits Tea/Coffee Sandwich	60 / 180 / 90 / 50 / 200

Additional Notes

Breakfast Total: 0 kcal

Lunch Total: 0 kcal

Dinner Total: 0 kcal

Snacks Total: 0 kcal

Daily Total: 0 kcal