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Ready for Healthy Weight?
Help us gather information so we can create a treatment plan for you
10
Questions
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1
Tell us Your Name
we can't wait to meet you!
First Name
Last Name
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2
Email
you@you.com
example@example.com
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3
Phone Number
we can call or text
Please enter a valid phone number.
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4
What is the Best Day or Time to Reach You
Evenings are OK!
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5
Tell us your current weight
uh oh
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6
Your goal weight?
ya hoo!
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7
Do any of the following apply to you?
Pancreatitis
Are You Currently Pregnant?
History of Thyroid Medullary Cancer
Hypoglycemia
None of the Above
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8
What methods of exercise have you used
Cardio
Yoga
Other
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9
Have you tried any of these for Healthy Weight?
Keto
Low Carb
Whole 30
Other
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10
What (if anything) would prevent you from joining our 3 month Healthy Weight Program?
This question allows us to serve you better
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