Please provide as many answers as you are COMFORTABLE sharing (all information is strictly confidential and will not be shared outside our company). The more you share to more we can prepare for your personalized consultation. We look forward to speaking with you soon!

PLEASE MAKE SURE TO HIT THE SUBMIT BUTTON AT THE BOTTOM OF THE FORM.

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What is your age?

Gender:

What is your current weight?

On a scale from 1-10, how committed are you to achieving your weight loss goals?

What is your biggest motivation for losing weight?

What other diets (or programs) have you tried in the past?

When it comes to finally losing the weight and taking control of your health, which type of investment feels most doable for you right now?

Small monthly commitment (~$100-$150)

Moderate monthly investment (~$300-$400)

Larger, results-driven investment ($500+)

Have you tried any weight loss products or supplements in the past?

Did you maintain your weight loss for a year or more on any of the diet programs you have tried in the past?

Which common symptoms of weight gain do you have? (Choose all that apply.)

Do you have any health conditions you take medications for?

Do you regularly use anything (even over-the-counter) to help with pain, digestion, energy, or sleep?

Do you have strong cravings for sugar, carbs or processed foods and often can't stop eating?

Is there a daily or weekly treat you grab that helps get you through the day—like coffee runs, energy drinks, sweet snacks, etc.?

What would you do more of when you achieve your weight loss goal?

If you could lose 20-40 lbs in the next 8 weeks with a proven doctor-designed, would you feel comfortable making a monthly investment in yourself to make that happen?

Yes, I value my health enough to invest

Maybe-- depends on the structure

Not right now

What is the most difficult part about managing your weight? (Check all that apply.)

Do you currently see, plan to see, or in the past year have you seen a chiropractor, physical therapist, or massage therapist to help manage pain, discomfort or stiffness?

Are you currently subscribed to any health or wellness programs, memberships, apps, or supplement routines?

What are the most important factors you are looking for in a weight loss program? (Check all that apply).

FAST WEIGHT LOSS (many of our clients lose 10%-12% total body weight in 60 days)

EAT REAL FOOD FROM THE GROCERY STORE (our program has NO bars, shakes or pre-pacakaged foods)

CLIENT SUPPORT (you'll meet with your weight loss coach weekly, plus get access to our mobile/computer app that allows you to send questions to our support staff 7 days a week)

KEEPING THE WEIGHT OFF - No More Yo-Yo Dieting (our proprietary program helps restore your metabolism so this can be the last weight loss management program you ever go on)

COST OF THE PROGRAM (our cost per pound of weight loss is among the lowest around and we have multiple plans available to fit your exact needs)