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ONLINE DIET TUTORIAL
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ONLINE DIET
    
   HOME       REGISTER       REQUEST PASSWORD       FAQ    
 step one of four of our online diet clinic registration

Please complete the form below to join our growing group of online dieters who successfully lose weight in the privacy of their homes. The registration process consists of four steps:   STEP ONE  you enter your contact details;   STEP TWO  you give a short medical history;   STEP THREE  you enter your delivery address; and   STEP FOUR  you order your 4-week or 8-week kit depending on how many kilo's you want to lose.
 
NEW USERS .. Username
  EMAIL ADDRESS (Username) *
  RETYPE EMAIL ADDRESS TO VERIFY *
IMPORTANT: MAKE SURE THAT YOUR EMAIL ADDRESS IS ENTERED CORRECTLY
NEW USERS .. Password
IMPORTANT .. Please don't use any special characters such as a ~, ', ", #, etc. – only letters and / or numbers.
  PASSWORD * (minimum 6 characters)
  CONFIRM PASSWORD * (minimum 6 characters)
  PASSWORD SECURITY: Where were you born? *
NEW USERS .. Personal Details
  NAME *
  SURNAME *
  HOME ADDRESS *
  TOWN / CITY *   POSTAL CODE *
  PHONE .. Work *   PHONE .. Home *
  PHONE .. Cellular *   2ND EMAIL ADDRESS
  WHERE DID YOU HEAR ABOUT MEDI-SHAPE? *
NEW USERS .. Body Shape Details
  HEIGHT IN CM *   AGE IN YEARS *
  CURRENT WEIGHT IN KILOGRAMS *
  GENDER *   Male     Female
  BUILD *   Small     Medium     Large

¹ TIP .. Wrap your thumb and major fingers around the smallest part of your wrist: Small Frame – the fingers overlap, Medium Frame – the fingers barely touch, or Large Frame – the fingers don't touch.
ONLINE DIET MANAGED BY
TEL. +27 (0)21 554 4401 / 21
CELL. +27 (0)72 340 7339
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DIET HUMOR
FAMOUS EXCUSE ... I have heavy bones.

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