Please provide as many answers as you are COMFORTABLE sharing

(all information is strictly confidential and will not be shared outside our company). The more you share, the better we can prepare for your personalized consultation in order to help serve you best!

We're looking forward to speaking with you shortly and getting you

started on your health journey!

Email *

What is your age?

Gender

Male

Female

Prefer not to say

What is your current weight?

On a scale from 1-10, how committed are you to achieving your weight loss goals?

What other diets or programs have you tried in the past?

Did you maintain you weight loss for a year or more on any of the diet programs you have done?

Have you tried any weight loss products or supplements in the past?

Which of these common symptoms of weight gain do you have?

Do you have any health conditions your take medications for:

Do you currently see, plan to see, or in the past year, have you seen a chiropractor, physical therapist, or massage therapist to help manage pain, discomfort or stiffness?

Do you have strong cravings for sugar, carbs or processed foods, and often can’t stop eating?

Is there a daily or weekly treat that you grab that helps you get through the day when you're stressed or tired-- like coffee runs, energy drinks, sweet snacks, etc.?

What would you do more of when you achieve your weight loss goal?

If you could lose 20-40 lbs in the next 8 weeks with a proven doctor-designed program, would you feel comfortable making a monthly investment in yourself to make that happen?

Yes, I value my health enough to invest

Maybe-- depends on the structure

Not right now

Do you keep eating when you are full?

What is the hardest part about managing your weight? (check all that apply)

What are the most important factors you are looking for in a weight loss program? (check as many as applicable)

When it comes to finally losing weight and taking control of your health, which type of investment feels most doable for you right now?