Welcome

1

Name

First Name

Last Name

2

Email

example@example.com

3

Phone Number

Please enter a valid phone number.

4

What is the best way to contact you?

5

WHAT SYMPTOMS DO YOU HAVE?

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6

What was your highest weight, current weight, goal weight?

7

Are there any health or wellness issues you would like to work on? ex. blood sugar, fatigue ect.

8

What is your biggest frustration with losing weight?

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What have you tried so far that hasn't worked for you?

10

What's your biggest fear when it comes to NOT losing weight?

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What would you be willing to do to lose weight?

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If you could have one question answered about losing weight, what would it be?

13

What is your #1 motivation for losing weight?

14

Have you always been overweight?

15

When you want to give up what inspires you to keep going?

16

What is the #1 thing you look forward to when you hit your goal weight?

17

Do you have support on your weight loss journey?

18

Do you have a favorite exercise?

19

What is one thing you want to give up that you will miss the most?

20

how often do you use caffeine products? example coffee, tea, soda ect.

frequently

sometimes

rarely

never

21

How often do you try and diet?

frequently

sometimes

rarely

never

22

How often do you drink water?

frequently

sometimes

rarely

never

23

How often do you exercise?

frequently

sometimes

rarely

never

24

How many meals do you eat a day?

25

How many meals do eat out in a week?

26

How often do you have bowel movements?

27

Have you ever tried any detox products?

YESNO

28

Have you ever tried meal replacement shakes?

YESNO

29

Have you ever tried TruVy products?

30

Who referred you to TruVy?

31

Would you like to receive coupons for our wonderful products?

YESNO

32

Are you interested in learning how to make money while losing weight or getting your products for FREE!

YESNO