Your Name *

Last Name *

Age *

Country

Email *

Delivery date

Pickup date

Please describe in detail(150+ words) the physical challenge you're facing. *

How does it affect your life? What have you tried before? What is your primary goal for this 8-week journey?

Please upload a short (under 60s), unedited "selfie" style video. *

Choose file or drag here

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Briefly introduce yourself and explain your situation. This is crucial for us to get to know the real person behind the story.

Social media (Optional, but helps!)

Share your most active social profile link (e.g., Instagram, Facebook).

I have read, understood, and agree to the terms of the PRUNGO Pilot Program, including the 8 weeks of feedback, the refundable deposit, and the reward structure.

Thanks for getting in touch!

We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

Thanks for getting in touch!

We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

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