HOW MUCH WEIGHT WOULD YOU LIKE TO LOSE?
10 - 20
20 - 40
MORE THAN 50
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HOW LONG HAVE YOU BEEN OVERWEIGHT?
LESS THAN 1 YEAR
1 - 3 YEARS
MORE THAN 3 YEARS
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HAVE YOU TRIED OTHER PROGRAMS BEFORE?
YES
NO
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HOW IS YOUR ENERGY AND SLEEP LEVEL?
GOOD
NOT TOO BAD
NOT GOOD
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HOW MANY MEDICATIONS ARE YOU ON?
0
1 - 3
MORE THAN 3
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DO YOU HAVE JOINT PAIN?
YES
NO
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DO YOU STRUGGLE WITH BRAIN FOG OR FOCUS?
YES
NO
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WHAT TIME ZONE DO YOU LIVE IN?
PACIFIC
MOUNTAIN
CENTRAL
EASTERN
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DO YOU HAVE A PREFERENCE FOR WHEN WE CALL YOU?
MORNING
AFTERNOON
AFTER 5:00PM
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WILL THIS APPOINTMENT BE:
Phone Consultation
In-house Consultation
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CONTACT US