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Newfoundland and Labrador
Prince Edward Island
(AU) Australian Capital Territory
(AU) New South Wales
(AU) Northern Territory
(AU) Western Australia
(AU) South Australia
(ZA) Western Cape
(ZA) Eastern Cape
(ZA) KwaZulu Natal
(ZA) North West
(ZA) Northern Cape
(ZA) Free State
My State is not listed
Combined annual family income.
10 lbs or less
How much weight would you like to lose?
.Are you determined to lose this weight for good?
What is your current weight & goal weight? (Please list both)
What is your biggest struggle with reaching your goal?
What do you think has prevented you from achieving your goal?
Why have you decided to overcome them now?
If you are still struggling with the same challenges one year from now, how will you feel?
How will you feel about yourself in 12 months from now if you commit to yourself and achieve your goals?
Why is it important to you to lose this weight?
1 - EXTREMELY important!!! I'm ALL IN!
2 - Important but not sure I'm ready to commit
3- Kinda important but not a priority
4 - Slightly important
5 - Not at all important to me
On a scale from 1-5, how important is it for you to end your weight struggle and achieve your goals?
Are you willing and ready to make a financial investment and time commitment to solving your obstacles and FINALLY achieving the results you want? If so why or why not?
Why do you think I am the right person to help you make these changes?
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