Weight Loss Survey, Your Personal Fat Loss Guide

Weight Loss Survey

This is the weight loss survey which will result in an HOUR long consultation with a certified management adviser and your personal Lifetime Fat Loss Low Glycemic Plan! You will also have me coaching you for 3 months to learn the skills you need to reach your ideal goal weight!

Some of the questions we will be exploring are:

Why are you having food cravings and what can you do about them?

What's causing your plateau?

If you are stuck because of hormone problems what can you do about that?

How can you burn fat efficiently?

Do you have insulin resistance and how do you reverse it?

How can you control your portions, shop for low glycemic foods, read labels so that you can identify preservatives that are high glycemic and stay within your food budget?

How can you finally achieve your ideal goal weight and stay there for a lifetime?

This is how it works. Fill out the survey below and click Submit. You will then be able to place your order for your hour long consultation, written Lifetime Fat Loss Low Glycemic Plan, and 3 months of coaching! I can offer all of this to you at the very affordable price of $65. You will be able to ask questions via email and talk to me once a week so I can check your progress and help you make necessary adjustments. I look forward to hearing from you and getting you started on a Lifetime of Fat Loss!

Weight Loss Coaching Survey

Please note that all fields followed by an asterisk must be filled in.

First Name*
First Name*

Last Name*
Last Name*

E-mail Address*
E-mail Address*

State/Prov*
State/Prov*

Country*
Country*

Home Phone*
Home Phone*

Age

Height

Weight

Frame

	Small Boned
	Medium Boned
	Large Boned

How many times a week do you exercise?

Describe what type of exercise you do:

What do you do for work?

Have you been on a diet before?

What was your biggest challenge in trying to stay on a diet?

What were your results?

What is your ideal goal weight?

Are you committed to working our plan for a minimum of 6 months?

Describe your health and any health challenges you are experiencing.

What else do you want to tell me about your struggle with excess weight?

The best times to reach me are...

	9:00 a.m. - 12:00 p.m.
	1:00 p.m. - 3:00 p.m.
	3:00 p.m. - 5:30 p.m.
	7:00 p.m. - 9:00 p.m.

The best day to reach me is....

	Monday
	Tuesday
	Wednesday
	Thursday
	Friday
	Saturday

I am in this time zone....

	Eastern
	Central
	Mountain
	Pacific

Please enter the word that you see below.

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SBI!

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Do you want to balance your metabolism, lower your blood sugar and have optimal health and longevity? Learn about the latest breakthroughs in the science of weight managment and how others are getting slender on the Lifetime Fat Loss Low Glycemic Plan!

Archived Newsletters

January 9, 2011 "2012 - Year of Right Intentions" - Issue #007

December 6, 2011 "Lifetime Fat Loss Holiday Tips" - Issue #006

November 2, 2011Eating Healthy On a Budget" - Issue #005

October 1, 2011"How To Stop Emotional Eating" - Issue #004

August 7, 2011 "A New Natural Fat Blocker" - Issue #003

July 3, 2011 "The Role of Cinnamon In Fat Loss" - Issue #002

May 24, 2011 "Eat Blueberries and Prevent Type 2 Diabetes" - Issue #001