Full Name
Email
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Phone
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Date of birth
What is your current weight
What is your weight loss goal?
10-25 lbs.
26-49 lbs.
50-100 lbs.
100 lbs or more
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What is your biggest health concern right now / what will we be discussing during this Discovery Call?
How long have you been struggling with this challenge?
How is this problem affecting your life? (i.e. is it preventing you from doing the things you love to do?)
Does this seem to be getting better, worse, or staying the same?
What have you tried previously and did anything work for you?
On a scale of 1-10 (10 being very motivated)...how motivated are you to FIX this problem?
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