Please apply to our program using the application below

Please complete the application below.

You will be notified if we feel you are a good fit for the program!

How many times do you eat at restaurants or fast food during the week?

Everyday

1-2

3-4

5-6

Never

What areas do you want toned?

Stomach

Back Fat

Thighs

Arms

All of the above

How soon would you want to get started?

In a few weeks

ASAP

Do you have permission from your spouse to hire a nutritionist?

Yes

No

Don't have a spouse

Are you willing to weigh in once per week?

Yes. Absolutely

No. I hate stepping on the scale

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