Name

Phone number

Email

How many meals do you eat in a day plus snacks? e.g. 2,3,4,5

Describe your activity factor Sedentary (desk job or sitting all day.Light active (maybe a teacher, mix of sitting, standing and light house activityModerate active(continuous activity like a restaurant server)Very active (goes to the gym or follows a fitness activity for 30 minutes and above a day.Heavy activity and Athletes( construction work)

Disease Animal protein allergyArthritisCancerDiabetesEpilepsyGastritisGastritis, ulcers and constipationGastro paresisGoiterHeart diseaseHigh cholesterolHIV and AIDs.HypertensionKidney diseaseNerve disordersPsoriasisSkin diseaseUlcersAcute Respiratory illness eg Asthma, Pneumonia

Indicate any allergies and specify. E.g. Wheat, cereal, milk, nuts, egg, etc.

Make an M-Pesa payment of Ksh 2,000/- to Buy Goods till number 763416 and enter the confirmation code to proceed