I'm looking for 10 people age 30-55 who want to lose 25 or more pounds. If this is you, please fill out the form below.
All eligible applicants will be contacted by phone.
Please enter your age
On a scale of 1-10, how committed are you to losing weight?
Which of the following describes your financial resources?
I have the financial resources to invest in my health right now
I can generate the financial resources to invest in my health but not right now
I don't have the financial resources to invest in my health any time soon
What is your favorite movie?
What are you struggling with most?
(Seriously) Why haven't you yet hit your goals in the past?
What is your target weight loss goal over the next 6 months?
Any other comments or feedback we should know about?
What is the best time of day to reach you over the phone?
Page 1 of 1
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service