JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
30 DAY DETOX GROUP
$100
venmo - @Charlene-Pifer
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Name
Your answer
Age
Your answer
Height
Your answer
Weight (Needed to Calculate Protein Goals)
Your answer
Activity Level
Light - Job is Mostly Sitting all Day (< 8,000 steps)
Moderate - Intermittent Movement Throughout the Day (8,000-14,000 steps)
Highly Active (>14,000 steps)
Clear selection
What are your goals and expectations for these 8 weeks?
Your answer
Create an affirmation statement based on your goals above. This is a great tool to keep you on track and writing it out every morning makes the connection to remember your "why" and what is important to you.
Examples: I am eating healthy and feeling great. I am supporting my fitness goals through nutrition. I am eating foods that allow me to keep up with my active family. I am focused and reaching my goals.
Your answer
What do you need to be successful?
Your answer
What is your "Why"? Why are you comitting to a health change?
Your answer
You are 100% in control of your results. Please sign below that you are entering into a contract to invest in yourself and complete the challenge as designed.
Your answer
Send me a copy of my responses.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Help Forms improve
Report