Clean Keto Quiz
Thanks for stopping by! Your answers to these questions will help us to determine how quickly you are likely to start to lose weight by implementing a clean ketogenic lifestyle. A member of our team will reach out to you within 12 hours. Please check your junk/spam folder for our reply! 🥑
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Email *
What is your phone number? *
First Name *
Weight in Pounds *
Height in Feet *
Age *
What is your approximate weight goal? (pounds) *
In adulthood, when was the last time that you were at your target weight? *
Do you have difficulty losing weight despite best efforts? *
Are you currently following a ketogenic or low-cab diet? *
Do you have any dietary restrictions, allergies or intolerances or digestive issues? Please list them or write NA if this does not apply to you. (ie, vegetarian, lactose intolerant, IBS, gallbladder issues, etc.) *
Do you have Diabetes? *
Are you taking any medications and/or have you been diagnosed with a medical condition that might interfere with weight loss attempts? *
When it comes to making lifestyle choices, if properly guided and supported by a coach, how would you rate your willpower or ability to stick to a plan? *
How did you hear about us? *
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