Free Wellness Assessment

1. Personal Information

Tell us a little about yourself so Coach Raju can tailor your assessment accurately.

Full Name *

Country of Residence *

Age Range *

Preferred Language *

Email Address *

WhatsApp / Phone Number Optional, used for direct habit assessment summary

2. Primary Wellness Goal

What is the most important health or lifestyle area you would like to focus on?

Healthy Weight Management

Build sustainable habits to lose or manage weight without crash diets.

Better Food Habits & Nutrition Awareness

Understand mindful eating, avoid late night snacking, and balance your meals.

More Physical Activity & Movement

Overcome sedentary desk lifestyle and integrate consistent movement.

Better Daily Routine & Consistency

Overcome procrastination, build morning/evening rhythms, and stay on track.

Restful Sleep & Recovery

Improve sleep quality, reduce evening screen fatigue, and wake up refreshed.

General Holistic Wellness & Longevity

Long term vitality and feeling energetic throughout the day.

3. Everyday Lifestyle & Daily Patterns

Help us understand how your typical day looks right now.

Current Activity Level *

Typical Daily Water Intake *

Current Eating Pattern *

Typical Sleep Hours *

What has been your biggest challenge in the past? *

Any specific goal or message for Coach Raju? (Optional)

I agree to the collection and use of the information I provide for the purpose of responding to my wellness enquiry, according to the Privacy Policy. (Your details are strictly confidential and never shared with third parties).

1. Personal Information

2. Primary Wellness Goal

3. Everyday Lifestyle & Daily Patterns

Assessment Received, Friend!