4WFT: Taking Off the Pressure
Registration form for 4-Week Fast Track program (1/31/18 - 2/21/18):

From 1/31/18 - 2/21/18, we will host a private Facebook group and launch a weekly live video (which will be archived on the group wall) to help you take the pressure off your blood vessels, manage hypertension, and regulate your sodium intake.

The program is 100% online and you can work at your own pace. You will have lifetime access to the videos, downloadable materials, and the private Facebook group.

Program agenda:
- Week 1: Welcome & introductions. Know your numbers & habits (establish a baseline).
- Week 2: Nutrition education. Habit-building and goal-setting.
- Week 3: Cook/prep skills and strategies, including recipes.
- Week 4: Wrap-up. Track performance. Set up future goals.

Investment: $28 for 28 days. Register by Mon, 1/29/18 (we will send you a payment request for $28 once we receive your registration).

Email address *
Name (First and Last) *
Your answer
Facebook profile name (i.e., how to find you on Facebook) *
Your answer
Age *
Your answer
City, State Zip code (if in the U.S.) or Country *
Your answer
On average, how many times a week do you eat the following foods: *
0-1
2-5
more than 5
Fruits
Vegetables
Protein, animal-based (meat, chicken, fish, etc.)
Protein, plant-based (beans, peas, nuts, tofu)
Grains (cereal, rice, pasta)
Dairy (including yogurt)
On average, how many times a week do you: *
0-1
2-5
more than 5
Prepare home-cooked meals?
Purchase convenience foods (frozen dinners, bagged snacks)?
Eat at fast food restaurants (Burger King, McDonald's, Chinese food, etc.)?
Eat at dine-in restaurants (local French bistro, Italian cafe, etc.)?
Do you have access to the following kitchen appliances/equipment? *
Yes
No
Stove/oven
Microwave/toaster oven
Refrigerator/freezer
Blender/Vitamix/Nutribullet
Measuring cups & spoons
Where do you usually purchase groceries/produce? (select all that apply) *
Required
Do you follow any particular diet or have food restrictions/allergies? *
Your answer
Do you have access to a blood pressure monitor (at-home cuff, doctor's office, free pharmacy service)? *
What do you expect to take away from this program? *
Your answer
Do you agree to the terms and conditions of the program? (view at http://bit.ly/2GboeSp) *
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