SELF DECLARATION MEDICAL I, _____________________________, understand that I am enrolling for the 23BMI weight loss program with complete information and understanding of it. I’m fully aware that it is recommended to get a blood profile check done and the report be shared with 23BMI before enrolling on 23BMI weight loss program, which is a standard operating procedure, by 23BMI. However, I declare that I’m totally fit to start the program and would like to go ahead without conducting a blood profile check and take full responsibility of the same. Signature: Tel: (+91) 7719000066 Date: Email: getfit@23bmi.com Web: www.23bmi.com