First Name *

Email *

Phone *

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

1. How do you feel most days? *

A. Tired, sluggish, or drained (even after sleeping).

B. Bloated, puffy, or inflamed.

C. Stressed, anxious, or struggling with cravings.

D. Pretty good, but I know I could feel better.

2. Which of these health concerns apply to you? *

Unwanted weight gain (especially belly fat).

High blood sugar, insulin resistance, or Type 2 diabetes

High blood pressure or cholesterol.

Joint pain, inflammation, or stiffness

Fatigue, brain fog, or low energy.

Cravings for sugar, carbs, or junk food

Mood swings, stress, or anxiety.

Other

3. How long have you been struggling with these issues? *

A. Less than a year. 1

B. 1-3 years.

C. More than 3 years.

D. I can’t remember a time I wasn’t struggling

4. What diets or programs have you tried in the past? *

Counting calories or portion control (Weight Watchers, MyFitnessPal)Option 1

Low-fat or plant-based diets.

Meal replacement shakes or detox cleanses

Keto, low-carb, or intermittent fasting.

I haven’t tried anything consistently.

5. What happened when you tried those methods? *

A. I lost weight, but I gained it back.

B. I felt hungry, deprived, or like I was missing out.

C. I had some success, but I couldn’t stick with it long-term.

D. Nothing worked at all—I’m still stuck

6. What’s the biggest challenge when it comes to eating healthy? *

A. I don’t have time to cook or plan meals.

B. I crave sugar, carbs, or comfort foods.

C. I don’t know what to eat (so much conflicting advice!).

D. I eat well most of the time, but I’m still not seeing results

7. If nothing changes in the next year, what worries you most? *

A. My weight will keep going up, and I’ll feel even worse.

B. I might have to start (or stay on) medications for blood sugar or blood pressure.

C. I’ll still be exhausted, in pain, and unable to enjoy life fully.

D. All of the above—I need a solution that works.

8. If you could achieve one goal in the next 90 days, what would it be? *

A. Lose weight and keep it off—without feeling deprived.

B. Get my blood sugar and blood pressure under control naturally.

C. Have more energy, better sleep, and less stress.

D. All of the above—I want total health transformation

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