What's Your Current Weight?
*
How tall are you?
*
Have you used a weight loss medication within the past 3 months?
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Yes
No
What is your sex assigned at birth?
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Female
Male
Other
Which of the following do you struggle with?
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Slow metabolism
Hunger
Cravings
Stress eating
Nighttime eating
Not enough exercise
Other
Which of the following have you tried in the past?
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Dieting
Exercise plan
Coaching
Weight loss medication
Other
First Name
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Last Name
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Date of birth
*
Email
*
Phone
*
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