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You're Eligible For Treatment

What's Your Current Weight? *

How tall are you? *

Have you used a weight loss medication within the past 3 months? *

Yes

No

What is your sex assigned at birth? *

Female

Male

Other

Which of the following do you struggle with? *

Slow metabolism

Hunger

Cravings

Stress eating

Nighttime eating

Not enough exercise

Other

Which of the following have you tried in the past? *

Dieting

Exercise plan

Coaching

Weight loss medication

Other

First Name *

Last Name *

Date of birth *

Email *

Phone *

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