Please Answer the Following Questions:
Do you want to lose more than 15 pounds?
*
Yes
No
Have you ever been prescribed medication for the following conditions?
*
High Blood Pressure (Hypertension)
High Cholesterol
Obesity (BMI 30+)
Cardiovascular diseases (heart disease, stroke)
Chronic respiratory diseases (COPD, asthma)
Immunosuppression
Infertility (female)
Thyroid disorder
Type 2 Diabetes
Depression
Osteoarthritis
Alcoholic Fatty Liver Disease
Reflux
Sleep Apnea
Cancer (not currently in treatment)
None of the Above
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You must have a BMI of 27 or one of the above conditions to be qualified medically.
The Basics
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Legal Last Name
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Email
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