iDECIDE New Member Registration Form

New Member Registration Form

Congratulations on taking the action to manage your weight with the iDECIDE Program!

iDECIDE is:

A doctor-supervised holistic weight management program that further supports you to achieve weight loss and long-term weight maintenance. iDECIDE has helped millions of patients develop healthier diet with smaller food portion and better lifestyle habits that is sustainable and life-long.

As an iDECIDE member, you are entitled to these benefits:

Weight management kit
iDECIDE membership card privileges
Monthly eNewsletters
Nutrition workshop
Fitness classes
Discount vouchers for health products
Complimentary passes for fitness centre and assessment
Nurse Counselling

Please fill out this online registration form to activate your membership privileges. This form will take approximately 8 minutes to complete. Do make sure that your email address is correct, so that we can get back to you. Thank you!

All fields are mandatory. All information provided will be treated in the strictest confidence. To learn more about our privacy policy, please click the link at the end of the page.

iDECIDE Enrolment Form

All fields are mandatory

Part 1 - Personal Particulars
Title	:
Full Name (as in NRIC)	:
Preferred Name	:	How do we address you?
Date of Birth	:
Gender	:	Female Male
iDECIDE Membership No.	:
Home Address	:
Postal Code	:		Country	:
E-mail address	:
Home No.	:		Office Number	:
Mobile No.	:
Race	:		Other Race	:

Part 2 - Clinic & Course Information
Clinic Name	:
Clinic Location	:
Doctor Name	:
Date of Enrolment	:	When did you start your treatment?
Current Course Number	:	One course is 3 months of treatment.

Part 3 - Personal Information
Reason To Lose Weight	:
Height	:	cm
Current Weight	:	kg	Current Waistline	:	inches
Reason To Lose Weight	:
Ideal Weight	:	kg	Ideal Waistline	:	inches
Achieve Ideal Weight in	:	When will you like to reach your ideal weight?

By clicking on the "I Agree" button below, I declare that I have understood the terms written above and I am aware that I will be contacted by an iDECIDE representative in due time.

If you do not possess a valid membership card or wish to learn more
about the iDECIDE Program, click here.

Privacy Statement: We respect your privacy and will never share your email address and personal information.
Read more about our Privacy Policy.