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Weight Management Survey
*
1.
Name & Age
(Required.)
*
2.
Contact Number
(Required.)
*
3.
What area of Trinidad are you from?
(Required.)
4.
Are you serious about managing / losing weight?
yes
no
5.
How much weight would you like to lose?
5-10lbs
10-20lbs
20-40lbs
40-60lbs
60-100lbs plus
6.
What have you tried in the past to manage / lose your weight?
Dieting
Not eating
Exercising
Gym
Other (please specify)
7.
If you did try something before, Why didn't it work?
lack of consistency
laziness
i don't know
no motivation
Other (please specify)
8.
WHY do you want to manage / lose weight now?
Health reasons
image
self esteem
Other (please specify)
9.
If you knew that there is a 30 day money back guarantee that comes attached to our programs, how much would you be willing to invest in your health?
$TT400-$TT800
$TT800-$TT1200
$TT1200-$TT1600
$TT1600-$TT2000+
10.
I work with appointments
What days are you usually available?
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Other (please specify)
Current Progress,
0 of 10 answered