Name / Nama penuh

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Give your full name / Sila beri nama penuh anda

This is a required question

Nickname

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Your short name / Nama pendek anda

This is a required question

Telephone Number/ No.Telefon

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Give your active contact number / Sila masukkan nombor yang mudah untuk kami hubungi

This is a required question

Where did you get this information ? / Dari mana anda mendapat maklumat tentang kami ?

*
please provide your friend’s name or his/her social account / Sila berikan nama rakan anda atau akaun media sosialnya

This is a required question

Occupation / Pekerjaan

*

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E-mail/ E-mel

*

This is a required question

Convenient contact time/ Masa lapang untuk dihubungi

*
Please choose your convenient time to answer the call / sila pilih waktu yang mudah untuk anda menjawab panggilan kami

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  Morning /Pagi  (9:00 – 12:00)
  
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  Noon / Tengah hari / petang (12:00 – 17:00)
  
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  Night/ Malam (17:00 – 22:00)
  
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  Other:
  

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Skype account or Line ID or Wechat ID /Akaun Skype atau ID Line atau Wechat ID

*

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Facebook acc / Akaun Facebook

*

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State / Negeri

*
please fill up with your district and country / sila isi beserta daerah dan negara

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Height/Tinggi

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in cm / dalam cm

This is a required question

Weight/Berat

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in kg / dalam kg

This is a required question

Fat percent / Peratus lemak (%)

skip if you did not know your fat percent / kosongkan jika anda tidak tahu peratus lemak anda

This is a required question

Birthday/ tarikh lahir (yyyy / mm / yy)

*

This is a required question

How many kg that you want to lose/gain ? / Berapa banyakkah berat yang anda ingin turunkan/naikkan ?

*
in kg

This is a required question

Why do you think you are too fat or too thin ? / Mengapakah anda terlalu gemuk atau terlalu kurus ?

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ex:overeating,loss of appetite / kerana terlebih makan, selepas bersalin, hilang selera makan…

This is a required question

Is it the way you’ve been doing to lose weight? / Apakah cara yang telah anda lakukan untuk mengurangkan berat badan ?

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ex: acupuncture, exercise, diet, medicine / senaman,diet,akupuntur,ubat tambahan

This is a required question

Why you want to change ? / Mengapa anda ingin berubah ?

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because… people always insulting me / kerana orang ramai sering menghina saya ..

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Do you think you really serious to change your fate ?/ Adakah anda benar benar serius untuk mengubah nasib anda?

*

This is a required question

Constipation problem? Difficult to defecation everyday ? / menghadapi masalah sembelit atau susah untuk membuang air besar setiap hari ?

*

This is a required question

How many litres you drink per day ? /Berapa litre air kosong yang diminum pada setiap hari ? *

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coffee,soup,tea are not included / kopi teh dan sup tidak termasuk

This is a required question

Your food criteria / Citarasa makanan anda

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  must follow my criteria / mesti menepati citarasa
  
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  don’t care as long i can eat / tidak kisah
  
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  Other:
  

This is a required question

Do you take any other food supplement ? / adakah anda mengambil makanan tambahan ?

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state type of supplement / nyatakan jenis ubat dan kegunaanya

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How often you sleep after 12 am ? / Berapa kerap anda tidur selepas pukul 12 tengah malam ?

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  Often/Sering
  
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  Sometimes / Kadang kadang
  
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  Never / tidak pernah
  

This is a required question

Does your family will be denied if you follow our program? / Adakah keluarga anda akan membantah jika anda mengikuti program kami ?

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  Yes / Ya
  
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  They always support me / Mereka selalu menyokong saya
  
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  No, i will make my own decision / Tidak , keputusan bergantung pada saya
  

This is a required question

Your health ?

*

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  Gout
  
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  Asthma
  
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  Nasal allergies
  
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  Skin allergies
  
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  Constipation
  
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  Diarrhea
  
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  Headache
  
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  Lethargic / tired easily
  
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  Colds
  
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  Blood pressure problems (hypertension / hypotension)
  
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  Diabetes
  
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  Liver function
  
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  Gastrointestinal problems
  
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  Menstrual problems (denial or hurts)
  
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  Heart disease
  
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  Thyroid
  
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  Edema
  
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  Kidney disease
  
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  Anemia
  
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  Metabolic problems
  
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  Other:
  

This is a required question

Your daily food menu ?/ Menu makanan harian anda?

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how many times do you eat everyday ? / berapa kali anda makan untuhk sehari ?

This is a required question

What is your daily expenses to buy food? /Berapakah perbelanjaan harian anda untuk membeli makanan ?

*
for ex: RM7 + RM5 + RM6 + 20 = RM38 for breakfast, lunch, tea, dinner / contoh : RM7+RM5+RM6+20 = RM38 untuk breakfast,lunch,tea,dinner

This is a required question

If this is the last time you lose weight, how long you want to spend the time to lose weight ? /Jika ini adalah kali terakhir untuk anda mengurangkan berat badan, berapa tempohkah yang anda inginkan untuk mencapai impian anda? *

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  Within 3 months / Dalam masa 3 bulan
  
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  3 to 6 months / 3 hingga 6 bulan
  
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  To achieve the effect of a long time, it does not matter / untuk kesan yang bagus ,saya tidak kisah
  
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  As soon as possible,/ lagi cepat lagi bagus
  

This is a required question

Budget your expenses for a month? / Bajet perbelanjaan untuk sebulan ?

*
excluding water bills, house rent, car money. State the amount you can afford to provide for this program./tidak termasuk bil air, sewa rumah, duit kereta . Nyatakan jumlah yang mampu anda sediakan untuk program ini .

This is a required question