{"id":933,"date":"2025-11-26T11:01:13","date_gmt":"2025-11-26T11:01:13","guid":{"rendered":"https:\/\/www.dietbymanukapoor.com\/Consults\/?page_id=933"},"modified":"2025-12-29T06:52:05","modified_gmt":"2025-12-29T06:52:05","slug":"weight-loss-form","status":"publish","type":"page","link":"https:\/\/www.dietbymanukapoor.com\/Consults\/weight-loss-form\/","title":{"rendered":"Weight Loss Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"933\" class=\"elementor elementor-933\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-d31562f e-flex e-con-boxed e-con e-parent\" data-id=\"d31562f\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-a40673e e-flex e-con-boxed e-con e-child\" data-id=\"a40673e\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-bc6093b elementor-widget elementor-widget-heading\" data-id=\"bc6093b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">PCOS &amp; Weight Loss Consultation Form<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-69c748e xpro-form-btn--left elementor-widget elementor-widget-wpforms\" data-id=\"69c748e\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"wpforms.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<style id=\"wpforms-css-vars-979\">\n\t\t\t\t#wpforms-979 {\n\t\t\t\t--wpforms-container-padding: 0px;\n--wpforms-container-border-width: 1px;\n--wpforms-container-border-radius: 3px;\n--wpforms-background-color: rgba(0, 0, 0, 0);\n--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n--wpforms-container-shadow-size-box-shadow: none;\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-979\"><form id=\"wpforms-form-979\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"979\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/Consults\/wp-json\/wp\/v2\/pages\/933\" data-token=\"8f90c24acb307f260f9d20a14c8cea41\" data-token-time=\"1775398276\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-979-field_1-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"1\"><fieldset><legend class=\"wpforms-field-label\">Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-979-field_1\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][1][first]\" aria-errormessage=\"wpforms-979-field_1-error\" required><label for=\"wpforms-979-field_1\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-979-field_1-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][1][last]\" aria-errormessage=\"wpforms-979-field_1-last-error\" required><label for=\"wpforms-979-field_1-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-979-field_2-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-979-field_2\">Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-979-field_2\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][2]\" spellcheck=\"false\" aria-errormessage=\"wpforms-979-field_2-error\" required><\/div><div id=\"wpforms-979-field_3-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-979-field_3\">Phone No <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-979-field_3\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][3]\" step=\"any\" aria-errormessage=\"wpforms-979-field_3-error\" required><\/div><div id=\"wpforms-979-field_4-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-979-field_4\">City <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-979-field_4\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][4]\" aria-errormessage=\"wpforms-979-field_4-error\" required><\/div><div id=\"wpforms-979-field_5-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-979-field_5\">Your Profession <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-979-field_5\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][5]\" aria-errormessage=\"wpforms-979-field_5-error\" required><\/div><div id=\"wpforms-979-field_6-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"6\"><fieldset><legend class=\"wpforms-field-label\">Have you ever tried any PCOS weight loss diet before? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-979-field_6\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-979-field_6_1\" name=\"wpforms[fields][6]\" value=\"Yes tried with another dietician\" aria-errormessage=\"wpforms-979-field_6_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-979-field_6_1\">Yes tried with another dietician<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-979-field_6_2\" name=\"wpforms[fields][6]\" value=\"No random diet reels only\" aria-errormessage=\"wpforms-979-field_6_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-979-field_6_2\">No random diet reels only<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-979-field_7-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"7\"><fieldset><legend class=\"wpforms-field-label\">How important is it for you to kickstart your transformational journey <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-979-field_7\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-979-field_7_1\" name=\"wpforms[fields][7]\" value=\"Very Important\" aria-errormessage=\"wpforms-979-field_7_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-979-field_7_1\">Very Important<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-979-field_7_2\" name=\"wpforms[fields][7]\" value=\"I am not that serious about my health\" aria-errormessage=\"wpforms-979-field_7_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-979-field_7_2\">I am not that serious about my health<\/label><\/li><\/ul><\/fieldset><\/div>\t\t<div id=\"wpforms-979-field_9-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"9\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-979-field_9\" >PCOS Profession for<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-979-field_9\" class=\"wpforms-field-medium\" name=\"wpforms[fields][9]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-979-field_8-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"8\"><fieldset><legend class=\"wpforms-field-label\">Can you not afford 15k for 3 months for a fitter and confident version of you <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-979-field_8\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-979-field_8_1\" name=\"wpforms[fields][8]\" value=\"I&#039;m ready to invest 15k in my health if I like the plan\" aria-errormessage=\"wpforms-979-field_8_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-979-field_8_1\">I'm ready to invest 15k in my health if I like the plan<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-979-field_8_2\" name=\"wpforms[fields][8]\" value=\"No price matters more to me than my health\" aria-errormessage=\"wpforms-979-field_8_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-979-field_8_2\">No price matters more to me than my health<\/label><\/li><\/ul><\/fieldset><\/div><script>\n\t\t\t\t( function() 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