Register | NourisHer Foundations

Basic details

We will use these details for program communication and account setup.

Full name *

Age *

Email address *

WhatsApp number *

City *

Country *

Preferred language for communication

Your goals and challenges

Select all that apply. This helps us understand what matters most to you.

What would you most like to achieve? *

Lose weight Improve energy Reduce bloating Improve eating habits Exercise consistently Sleep better Manage emotional eating Feel confident around food

What currently makes progress difficult? *

Lack of time Lack of consistency Cravings Emotional eating Weekends and social events Poor sleep Stress Hormonal changes

Weight-loss goal

How ready do you feel? *

7/10

Still unsureReady to begin

At the end of 8 weeks, what would make you feel proud?

0/500

Health and lifestyle

This program is lifestyle coaching, not medical treatment. Please share information relevant to your safe participation.

Dietary preference *

Current activity level *

Do you have any diagnosed health conditions? *

Yes No

Please tell us about them

Are you currently taking any regular medication? *

Yes No

Please list relevant medication

Do you have any injuries or exercise restrictions? *

Yes No

Please explain any restrictions

Important

If any information indicates that medical clearance may be advisable, the coaching team may contact you before confirming participation.

Review and agree

Please review your information and confirm the participation terms.

Next step

After submitting, you will move to the payment stage. This demo saves the registration locally and shows a success screen.

Tell us about yourself

Basic details

Your goals and challenges

Health and lifestyle

Review and agree

Thank you, there!