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Welcome to your Quiz

How much weight do you want to lose?

Would love for a direct weight input or a sliding scale option.

None

What Weight loss methods have you tried in the past?

Diet Program

Exercise Program

Weight Loss Medications / Injections

Weight Loss Surgery

None

Are you on any medications?

None

1-2

3-5

5+

None

None

Name

Email

Phone

Time's up

Welcome to your Quiz

How much weight do you want to lose?

Would love for a direct weight input or a sliding scale option.

None

What Weight loss methods have you tried in the past?

Diet Program

Exercise Program

Weight Loss Medications / Injections

Weight Loss Surgery

None

Are you on any medications?

None

1-2

3-5

5+

None

None

Name

Email

Phone

Time's up

Welcome to your Quiz v4

None

how many of the following medications do you take?

Diabetes - 1

Diabetes - 2

Diabetes - 3 or more

Insulin - 1

Insulin - 2

Insulin - 3 or more

High Blood Pressure - 1

High Blood Pressure - 2

High Blood Pressure - 3 or more

High Cholesterol - 1

High Cholesterol - 2

High Cholesterol - 3 or more

Birth Control - 1

Birth Control - 2

Birth Control - 3 or more

Psychotropics - 1

Psychotropics - 2

Psychotropics - 3 or more

Weight Loss - 1

Weight Loss - 2

Weight Loss - 3 or more

Diuretic / Water Pill - 1

Diuretic / Water Pill - 2

Diuretic / Water Pill - 3 or more

Are you on any medications?

None

1-2

3-5

5+

None

How much weight do you want to lose?

1-15

15-30

30-50

Over 50 LBS

None

How much weight do you want to lose?

0

Over 50 LBS

What Weight loss methods have you tried in the past?

Diet Program

Exercise Program

Weight Loss Medications

Weight Loss Injections

None

How much weight do you want to lose?

Would love for a direct weight input or a sliding scale option.

None

Select Your Focus

(Select All That Apply)

Full Body Detox

Microbiome & Gut Health

Lifestyle Habits

Energy Levels

Lean Muscle

Fat Loss

Brain Fog

Cellular Health

Body Balance

Hormonal Health

What Weight loss methods have you tried in the past?

Diet Program

Exercise Program

Weight Loss Medications / Injections

Weight Loss Surgery

None

Any Surgeries or Implants?

Gastric Sleeve/Bypass

Lipo

Pacemaker

Defibrillator

Implants

Colectomy

None

Current or Past Conditions

(Select All That Apply)

Pregnant, Breastfeeding, Trying to Conceive

Cancer (Active, Treating Remission less than 2yrs)

Seizures

Kidney Disease Stage 3 or higher

Auto-Immune

Type-1 Diabetes (Born With)

Heart Disease

In a Wheelchair/Immobile / Disabled

Time's up

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