Loyal Customer
This questionnaire  is  designed  to help answer  basic questions  to best of your  ability to which  products  is the best fit for your. The products  are not intended to diagnose,  cure, treat  or prevent  any disease or health  conditions. It is strongly  recommended  to consult your  doctor  before  taking any  of the products.
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Name, Email, Phone Number *
Age Group *
What are you Allergic too? *
What's  your target  area? *
How much pounds you want loose? *
Are you experiencing any of the following? *
Stomach discomfort with foods
Skin breakouts
Bloating & Fagitue
Select all that apply
Row 1
Will you be willing to do our 90 days challenge or loyal  customer program? *
The 90 days challenge or Loyal customer  program is where you agree  to get a product for 3 months  in a row on automatic shipment. Save 40% off on all products. Access special monthly offers. Earn 10% back in Perks Point. A $50 membership fee is waived upon the completion of the 3 consecutive  autoshipments.
How much would you like to spend  month? *
How would you like to be contacted? *
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