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Brief Survey

You're one step closer to taking your health back!

Please answer the questions below to the best of your knowledge. The goal is to make sure your specific medical and health status are considered as we customize our weight loss program to meet your specific needs.

Are there any upcoming life events that may have influenced your decision to pursue weight loss?
Let’s say you had “a magic wand” and nothing could stop your weight loss-how many pounds would you like to lose?
On a scale from 1-5 how committed are you to making lifestyle changes necessary to reach your weight loss goals?
How many times have you tried to lose weight in the past?
If you tried to lose weight in the past what method(s) did you try?
What is your biggest concern or challenge in reaching your weight loss goals?

Thanks for submitting!

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