Complimentary Weight Loss Consultation Application
Monica is currently taking on clients. Please fill out the form to get a free weight loss consultation via phone call. Spots fill quickly.
Email address *
Name *
Your answer
Best Phone # for consultation *
Your answer
Current weight *
Your answer
Goal weight *
Your answer
Are you a motivated person? State the last thing you followed through with *
Your answer
How many diets have you tried in the past year? *
Your answer
Do you currently workout? Gym or home? *
Your answer
Are you training for a sporting event? half marathon, marathon, triathlon *
Your answer
Describe your current diet, in detail. *
Your answer
How likely are you to follow through with a goal without accountability? *
Not Likely
Very likely
What is currently holding you back from reaching your weight loss goals? *
Your answer
Why do you want to lose weight? *
Your answer
Would you rather remain the same or make significant changes to your lifestyle? *
Your answer
Do you have any thyroid issues? list below in detail *
Your answer
To get to the body of your dreams, and feel confident everyday for the rest of your life what is that worth to you? *
Best time of day to call *
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Best day to call *
Required
Did some one refer you to me? List person or blog below. I give credit to them *
Your answer
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