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(area code) ### - ####
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Best time to call
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How many pounds do you want to lose?
Do you need more energy?
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What have you tried before?
Why do you feel these other attempts did not work?
What is the most important reason for you to lose weight?
Do you have excess bodyfat or weight that you want to get rid of?
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Do you eat 3 meals a day?
Yes
No
If no, which meals do you skip?
Do you have a problem snacking?
Yes
No
If yes, at what time of the day is hardest to control?
Which of these best describes your own lifestyle?
Calm
Active
Stressed
Do you think you get 100% of the daily nutrition needed for good health?
Yes
No
Sometimes
Do you take nutritional supplements (vitamins/minerals/proteins)?
Daily
Never
Sometimes
Do you eat a variety of healthy foods from the basic food groups everyday?
Yes
No
If no, why not?
Not enough time
Too expensive
Too complicated
How serious are you about losing weight? *
Just Curious
Somewhat Serious
Very Serious
Amount that you would be willing to invest monthly to lose weight: *
Select Amount:
$0 - $20
$20 - $50
$50 - $100
$100 - $200
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