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LOSE WEIGHT NOW
I'LL SHOW YOU HOW

Have you ever seen this?
If so did you ever want to ask “how?”

Well I did ask “how” and I found out “how” and now I’d like to show you “how.” I began working with these amazing Nutrition Programs with my clients and we are getting astounding health and weight loss results. If you would like to know more about a Nutrition Program for yourself or someone you know please Click Here to contact me.

FOR YOUR FREE WELLNESS EVALUATION

Fill Out The Form Below!
If you would like to participate in a Wellness Evaluation please fill out the form below, it will take about 5 minutes and it is absolutely FREE! After you have answered the questions they will be sent to me and I will get in touch with you via email to discuss your results again this is FREE! It's that easy.

Why wait It’s free to find out how!!!

LOSE WEIGHT NOW
I'LL SHOW YOU HOW

Full Name *
Email *
Date *
What Are Your Specific Health and Wellness Goals *
Height *
Weight *
Age *
BMI *
Target Weight *
Gender *
Recommended Protein *
DOB *
Do you eat more meals w/ poultry, lean meat, fish & plant (soy) proteins rather than steaks, roast etc.?	Yes No
Do you eat a variety of colorful fruits & veggies & do you eat at least 7 servings a day of these?	Yes No
Do you consume primarily whole grains (100% whole wheat bread, pasta, brown rice) vs. white rice, regular pasta, white bread?	Yes No
Do you eat ocean-caught fish at least 3 x per wk?	Yes No
Do you avoid the intake of fried food, dressings, sauces, gravies, butter or margarine?	Yes No
Is your digestive system free from indigestion or irregularity?	Yes No
Do you get a minimum of 30 min of ex 3 –5 days per week?	Yes No
Have you maintained a stable wt for 2 – 3 yrs?	Yes No
Do you usually have time to prepare balanced meals, rather than take out or eat on the run?	Yes No
Do you stay away from soda & typical snack foods throughout the day & after dinner?	Yes No
Are you free of water retention & bloating?	Yes No
Do you have the energy & focus you need to meet your daily challenges w/o an afternoon lull?	Yes No
Do you drink at least 8 – 8 oz glasses of water each day.	Yes No
Are you getting your daily recommended allowance of calcium per day? a. Women under 50 = 1200 mg b. Women over 50 = 1500 mg c. Men = 1000 mg	Yes No
Are your blood pressure, triglycerides & bad cholesterol levels in the normal range?	Yes No
Men: Are you free from Problems assoc. with your prostate such as slow urination or waking in the night to urinate?	Yes No
Women: Are you free from problems with your menstrual cycle/menopause such as mood changes, hot flashes or problems sleeping?	Yes No

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LOSE WEIGHT NOW
I'LL SHOW YOU HOW!

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