Weightloss Options EVAL (To determine best program)

WHICH WEIGHTLOSS PROGRAM IS BEST FOR YOU?

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Full Name*

First NameLast Name
Phone Number*
Format: (000) 000-0000.
MaleFemale
Height
Weight
SemaGlutide

Semaglutide, sold under the brand name Ozempic among others, is an antidiabetic medication used for the treatment of type 2 diabetes and long-term weight management. Semaglutide acts like human glucagon-like peptide-1 (GLP-1) in that it increases insulin secretion, thereby increasing sugar metabolism. It is distributed as a metered subcutaneous injection.
New Wave detox and cellular resetLipo-sculpting Non Invasive Body ContouringFDA Approved Injections for weightloss and insulin resistance
What do you do for a living?
none(seated only)Moderate (light activity such as walking)High (heavy labor, very active)
Do you follow a regular working schedule, do you work days, afternoon or nights?
Please list the physical activities that you participate in outside of the gym and outside of work.:
If you have any diagnosed health problems list the condition(s).
If you are on any medications, please list them.
What additional therapies are being undertaken for the given health problem(s)?
If you have any injuries, please list them.
YesNo
YesNo
YesNo
if yes please list:
YesNo
low-fatlow-carbhigh-proteinVegetarian/VeganNo special diet
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Improved health (all 3 options)Improved endurance (all 3 options)Regulate insulin (Semaglutide)Cellulite improvement (Red Light)Spot reduction (Red Light)Decrease hunger (Semaglutide & New Wave)Restore vitamins and minerals (New Wave)Metal DETOX (New Wave)
What is your weightloss goal?

TImeline for achieving your goal.

Rows	8 WKS	16 WKS	24 WKS	32 WKS	40 WKS	1 YEAR
NOW

Age
years
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WHICH WEIGHTLOSS PROGRAM IS BEST FOR YOU?