Custom Protocol – Balwaan Vitality Program

Your Full Name *

WhatsApp Number (10 digits) *

1. Your Age Group

18-25

26-35

36-45

45+

2. Marital Status

Single

Married

3. Do you have any of these medical conditions?

High / Low BP

Diabetes

Thyroid

None of the above

4. Main health problems? (Select max 3)

Premature Ejaculation

Low Sperm Count

Erectile Dysfunction (ED)

Poor Timing / Control

Low Stamina / Fatigue

Low Testosterone Symptoms

Low Confidence

Mood Issues

Other

5. Your Goals? (Optional, max 2)

More Energy

Better Stamina

Better Sleep

Better Focus

Improve Confidence

Improve Sexual Health

Your Personalised Vitality Protocol