Struggling to lose weight?

Toxins, inflammation, hormones and your metabolism

may be the root cause of your weight challenges.

They’re working against you—and you don’t even know it.

Take this quick evaluation now to uncover what’s holding you back.

Why do you want to get healthy and lose weight? *

Health Issues

Feel confident in my body

Self Esteem / Self-Confidence

Balance my hormones

Reset Metabolism

Quality of Life (Longevity)

Doctor recommendation

Other (write your reason below)

Everyone's got a reason, what's yours?

Other

How much weight do you need to lose to reach your goal? *

Less than 20 lbs

21-40 lbs

41-60 lbs

60-80 lbs

80+ lbs

100+ lbs

Be real with us—how many pounds are you ready to say goodbye to?

When was the last time you felt great in your own skin? *

Less than a year ago

1–3 years ago

3–5 years ago

Over 5 years ago

Never

Think back—when did you last feel strong, confident, and in control?

What’s been your biggest struggle with weight loss? *

Lack of motivation

Diets that don't work

No time to focus on myself

Cravings/emotional eating

Hormones and/or metabolism issues

No support system

What’s been standing in your way?"

How long have you been trying to lose weight but not seeing the results you deserve? *

Less than a year ago

1-3 years ago

3-5 years ago

Over 5 years ago

I've been trying for years but not successful

On a scale of 1 to 10, how ready are you to go from breakthrough to transformation? *

1 (Not ready)

10 (I'm all in!)

Do you have any health challenges that are associated to your weight? *

High blood pressure

High cholestrol

Diabetes

Heart disease

Stroke history

Joint pain / Arthritis

Sleep apnea / Breathing issues

Cancer

Other

Click all that apply

Other (Fill in the blank)

How did you hear about our transformational program? *

Elvis Duran & The Morning Show

100.3 Z100

103.5 KTU

Q104.3

Power 105.1

106.7 Lite FM

710 WOR

ABC 7 NY

Facebook

Instagram

Tik Tok

Patient Referral

Family Member or Friend

Doctor Referral

How is this excess weight affecting your QUALITY OF LIFE? (Please be specific and give examples) *

Tell us in your own words.

Final Step – We Just Need Your Info

Alright, you’re almost there. Drop your info so we can reach out and get you started.

First Name

Last Name

Phone *

Email *

Date of birth

Opt-In

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