Well Centered Weight Loss Interest Form
To see if this program is right for you, I’d like to ask a few questions.
How did you hear about us?
How much weight are you looking to lose or what are your goals?
More than 100 lbs.
What have you tried so far?
What obstacles might restrict you from succeeding?
Why do this now?
What are your biggest frustrations regarding your health?
Thank you for your interest in my Well Centered Weight Loss Program!
After submitting this form, I will review your answers and let you know if it's a good fit. Cheers!
A copy of your responses will be emailed to the address you provided.
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