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Weight Achievement Centers - Semaglutide (Client's Website)
1
What Are Your Weight Loss Goals?
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Lose stubborn weight
Tighten up loose skin
Fit into smaller clothes
Feel comfortable in swim suit
Boost self-confidence
Other
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2
What Areas Are You Wanting To Improve?
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Abdomen
Back
Glutes/butt
Hips/thighs
Chin/neck
Chest (male)
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3
Has Previous Surgical Work Been Done On These Areas?
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Yes
No
It's complicated
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4
Do You Have Any Of The Following Medical Issues?
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Insulin Resistance
Pre Diabetes
Type 1 Diabetes
Type 2 Diabetes
High Blood Pressure
Hyperthyroidism
Hypothyroidism
Other Medical Issue
No Medical Issues
Pancreatitis
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5
How Many Days Per Week Are You Physically Active/Exercising?
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0 Days
1 Day
2 Days
3 Days
4 Days
5+ Days
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6
On Those Days, How Rigorous Is Your Activity/Exercise?
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Light
Moderate
Intense
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7
Are You On Any Of The Following Diets?
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Keto
Paleo
Vegan
Vegetarian
Other/None
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8
Any Questions About This Treatment?
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What will my results look like?
How long will it take to see results?
How many treatments will I need?
Other
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9
What Is Your Preferred Payment Method For This Treatment?
Financing
Self-Pay
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10
What Day Would You Prefer For Your Consultation?
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Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
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11
Can We Get Your Name?
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First Name
Last Name
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12
What's Your Best Email Address?
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13
Please Verify Your Cell Phone Number
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We'll text you a 5 digit code
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14
Terms and Conditions
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15
Sender
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