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I. GENERAL INFORMATION

What do you want MOST from my program? *

Which body type most closely matches yours? *

Apple shape - Tends to store fat around the belly and chest.

Pear shape - Holds the majority of fat in the lower body; hips, buttocks, saddlebags.

Banana shape - Has equal fat distribution; gains and loses weight evenly head to toe.

What do you consider your ideal weight to be (in pounds)? *

How long ago were you at your ideal weight? *

What do you do for work? *

Is your job physically demanding? *

Yes

No

Sometimes

Number of hours you work each week? *

Marital Status *

Number of children living with you? *

Do you (check all that apply): *

Do you have trouble falling asleep at night? *

Yes

No

What time do you typically wake up in the morning? *

How do you wake up each day? *

PLEASE CONFIRM YOUR DETAILS AND CLICK THE "NEXT" BUTTON.

(THIS COMPLETES PART 1 OF 3).

First Name *

Last Name *

Age: *

Gender: *

Male

Female

I am MOST interested in: *

Height: *

Current Weight: *

Goal Weight: *

Zip Code *

Phone Number *

Email Address *

UPLOAD PROFILE PIC (unfiltered) * 🛈

UPLOAD SWIMSUIT PHOTO (full length) * 🛈