Weight Loss Form | EM CHILLER

First name

Phone

What are your health goals?

What is your current body weight?

What is your goal body weight?

What have you tried in the past to lose weight?

How do you currently feel in your own body?

What would reaching your ideal body weight mean to you? How would it change your life?

Are you ready to make serious commitment to your health?

Yes, I'm ready

Not yet

Are you willing to make the changes necessary to reach your health goals?

Yes, I'm ready

Not yet

Are you 100% ready to let go of all excuses and finally get your health on track?

Yes, I'm ready

Not yet

Are you ready to invest in your health?

Yes, I'm ready

I am looking for someone who finally wants to take the step towards improved health and vitality. Someone who is going to commit and not fall into bad habits when life gets hard. Someone who is going to let go off excuses and work with me for 21 days with full comitiment and dedication to THEMSELVES. If thats you, if your ready to finally start living to your full potential and improve your health submit this form.