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Phone Number
+91 9940463866
E-Mail
humanprime.team@gmail.com
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Personal Details
Health & Body Profile
Movement & Lifestyle Assessment
Readiness & Commitment
Scheduling & Time Preference
Investment & Decision
First Name
Last Name
Age
Gender
- Select Gender -
Male
Female
Other
Phone/Mobile
Email
Country
Select Country
Afghanistan
Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belau
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Saint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
British Virgin Islands
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo (Kinshasa)
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Ivory Coast
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao S.A.R., China
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palestinian Territory
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo (Brazzaville)
Reunion
Romania
Russia
Rwanda
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin (Dutch part)
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia/Sandwich Islands
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom (UK)
United States (US)
United States (US) Minor Outlying Islands
United States (US) Virgin Islands
Uruguay
Uzbekistan
Vanuatu
Vatican
Venezuela
Vietnam
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
How did you hear about Human Prime?
Instagram
Referral
Google
Email
Other
Other
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Current Weight (kg)
Height (cm)
Do you know your approximate BMI?
Yes
No
Enter BMI
Do you currently experience any of these?
Knee pain
Lower back pain
Hip pain
Shoulder pain
Stiffness in morning
Shortness of breath during movement
None
Have you been diagnosed with any of the following?
Osteoarthritis (any joint)
Diabetes or Prediabetes
PCOS/PCOD
Thyroid disorder
High blood pressure
High cholesterol
Obesity (BMI 30+)
Other (please specify)
None
Are you currently taking any medications?
Yes
No
Please list the Medications
Have you worked with a coach/trainer before?
Yes
No
please specify what worked / didn’t work
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How would you describe your current activity level?
Sedentary (little to no activity)
Light activity (1–2 days/week)
Moderate (3–4 days/week)
Intense (5+ days/week)
Which of these daily movements feel difficult for you? (Select all)
Climbing stairs
Getting off the floor
Sitting for long periods
Carrying groceries
Bending / kneeling
Fast walking
None
How many hours do you typically sit in a day?
2–4 hrs
4–6 hrs
6–8 hrs
8+ hrs
How would you describe your sleep quality?
Excellent
Good
Average
Poor
Describe your stress levels.
Low
Moderate
High
Very high
What does your daily eating pattern look like? (Brief description)
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What is motivating you right now to start your transformation?
What are the top three outcomes you want in the next 3–6 months?
How ready are you to commit to guided coaching for 12 hours a month?
Fully ready
Need more clarity
Not sure
How many months can you commit to your transformation?
3 months
6 months
1 year or more
Our programs are structured, coach-guided, and require consistent weekly check-ins. Are you willing to follow this system?
Yes
No
Not sure
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Next
Which time slots work best for you? (IST)
- Select -
6 AM
7 AM
8 AM
9 AM
10 AM
11 AM
12 PM
3 PM
4 PM
5 PM
6 PM
7 PM
8 PM
9 PM
Preferred days for training (3 days/week):
Mon-Wed-Fri
Tue-Thu-Sat
Flexible
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Our programs range between ₹8,000–₹10,000 per month depending on structure and coaching. Are you comfortable with this investment?
Yes
I need more clarity
Not right now
When would you like to begin your transformation?
Immediately
Within 1 week
Within 2 weeks
Within 1 month
Is there anything else you want us to know before we speak?
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