Sign Up – Slim and Trim 10 days LifestylePage 3 of 4Personal InformationPlease fill in the following information as accurately as possible so that we can design a programme most suited to you and your goals.Gender*MaleFemaleDate of Birth* We currently only accept those over 18 years. If you are under 18, please call our team on 08456 123 888.Height*Height Units*Metres / centimetersFeet / inchesCurrent Weight*Current Weight Units*KgStone / poundsGoal Weight*Goal Weight Units*KgStone / poundsFood and DrinkFood Diary Please give us an indication of a typical days diet.How much water do you drink?We recommend 1.5 to 2 litres of water per day.Do you drink alcohol?NoYesWhat alcohol do you drink, how often and how much?Do you drink caffeinated drinks?NoYesWhat caffeinated drinks do you drink, how often and how much?ExerciseExercise Frequency*Exercise dailyExercise 3–5 times per weekExercise 1–3 times per weekRarely exerciseUnable to exerciseWe recommend raising your heart beat for an average of 30 minutes a day.What type of exercise do you do?*SmokingDo you Smoke?NoYesHow many cigarettes do you smoke a day?Work and StressOn a scale on 1–10 how stressed would you say you are?Please select...1234567891010 being the most stressedJob? Delivery DetailsPage 4 of 4Delivery InformationLength of programme required (days)*Please enter a value between 10 and 10.Delivery Schedule* Monday Friday Tuesday Saturday Wednesday Sunday Thursday Please indicate which days you would like delivery. You can change your delivery schedule by calling or emailing us and simply giving us two full working days' notice. Note that Saturday and / or Sunday food is delivered on a Saturday morning. Please check Sunday if you wish to receive food for Sunday, despite it being delivered on a Saturday.Start Date* Delivery Address* Street Address Address Line 2 City ZIP / Postal Code Billing address Click here if your billing address is the same as your delivery address Billing Address* Street Address Address Line 2 City ZIP / Postal Code Credit card? (There is no additional charge if you pay using a debit or maestro card) Pay with a Credit or Master Card +1.5 % There is a 1.5% charge to payments made with a Credit or Master Card. Please tick here if you plan to pay with your Credit or Master Card. Contact DetailsMobile Phone*Other PhoneConfirm Email Address*Contact Preference*EmailMobile PhoneOther PhoneDelivery Instructions*Please select...Front doorBack doorSide doorUse Key (we will contact you to organise)Leave with 24hr securityOtherWhere should we leave the bag? Like old fashioned milk deliveries we drop off between midnight and 6am.If other, please specify*Additional Delivery InstructionsPlease provide us with any additional instructions, especially if you are hard to find?PhoneThis field is for validation purposes and should be left unchanged.