Health Challenge Completion Form
Congratulations! You have completed the 40-day Health Challenge!
Email address *
Health Challenge Completion
By following our 40-day program and maintaining the healthy diet and exercise regimen, you have earned the chance to win $100 cash or a 3-day getaway at the Island on Lake Travis (Lago Vista, TX).
Please complete and submit the form below. You will be notified within 4 weeks if you are a winner!
Today's date: *
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First Name *
Your answer
Last Name *
Your answer
Address
Your answer
Health Challenge completion date:
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Height (inches):
Your answer
Weight:
Your answer
Waist line (inches):
Your answer
I certify that I have completed the Primero Health 40-day plan for a healthier me. (Enter name)
Your answer
Share your success!
We’d like to share your success story on our website with the Primero Health community! If you want to give us your permission to do so, please let us know below. Please send a before and after picture of yourself, along with a short story of your journey on the Path to Health to info@primerohealth.org. Due to limited space, not all stories will be featured.
I’m happy with my success in taking the Path to Health Challenge.
By checking the box, I give Primero Health, Inc. permission to use my success story and photos on their website.
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