Fit & Trim Study

1

I agree to be contacted about this study* This field is required.

I agree to be contacted about this study

2

Age* This field is required.

3

Height (feet)* This field is required.

4

Height (inches)* This field is required.

5

Weight (pounds)* This field is required.

6

BMI

8

Score

9

Have you tried any of the following to lose weight?

GLP-1 medications (Ozempic, Wegovy, etc.)

Diet programs

Exercise programs

None

10

Are you able to attend outpatient visits in the Bahamas if selected?

Yes

No

11

Do you have reliable transportation?

Yes

No

12

Is it difficult for you to climb 2 flights of stairs without stopping?

Yes

No

13

First Name* This field is required.

14

Email* This field is required.

example@example.com

15

Phone

Area Code

Phone Number

16

Priority