Client Record Form Personal Details Sex : MaleFemale Martial Status : SingleMarried Lifestyle Family History : DiabeticHypertensionThyroidHigh CholesterolOther's Smoking : YesNo Alcohol : YesNo Food : VegNon-veg Client's Medical Details Did you have any major surgery in the last 3 months? please give details Do you have any medical problem? If yes, then please give details Chest Pain : YesNo Diabetes : YesNo Thyroid : YesNo Hypertension : YesNo Asthma, Bronchitis, Cough : YesNo Heartburn, Gastric or Duodenal ulcer, Gallstones : YesNo Diarrhoea, Constipation, Colitis, Piles : YesNo Arthritis, Gout : YesNo Stroke, Epilepsy or other CNS disorders : YesNo Severe Depression or other Psyche Disorders : YesNo Allergy to Milk : YesNo Pregnant : YesNo CLIENT DECLARATION: 1. Above information given by me is correct. I have understood the details of the products / Services of Youth Factory Health & Beautty LLP. 2. In case there is any changes in my health of my selection of information given by me , I agree to notify the dietician of Youth Factory Immediately. 3. I consent to the Youth Factory Health & Beautty LLP dietician holding the data of this Medical Record Form in conjunction with the use of the programmes for further evaluation. 4. I have understood that the Products and services are not returnable or refundable. 5. Client declaration Details received by Email , Signature is not mandatory and will be deemed that all the above conditions are accepted. DISCLAIMER : Success Stories and results featured on this web site are typical. As individuals differ, so will results. Our products have been engineered and produced with the greatest care, to meet your complete every day need for nutrients, minerals and vitamins. Even so, your body may have different needs always check with your doctor for risks associated with dietary supplements that could impact your specific health conditions and/or allergies. NOT FOR MEDICAL USE : The products or services mentioned are not intended to be used to diagnose, treat, cure, mitigate or prevent any disease or health conditions. Each individual may get different results as per their medical conditions and metabolic rate. CAUTION : Do not exceed the recommended dose. It should not be used by pregnant, nursing and lactating women, or by infants, children under 14 and individuals with a known medical conditions should consult a physician before using any dietary supplements. CONDITION FOR SAlE: Products once sold will not be exchanged or taken back.