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First Name
*
Email
*
What is your current weight?
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What was your weight one year ago?
What do you hope to achieve with your health and weight loss in 2024?
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Do you have any underlying health conditions or medical concerns that may impact your participation in the Step it UP weight loss coaching program?
What areas of your life are affected by the weight? Choose all options that apply.
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Maintaining a safe environment
Communication
Breathing
Eating & drinking
Washing & dressing
Mobilization
Working & playing
Expressing sexuality
Sleeping
Daily parenting
Finances
Household chores
Self worth/value
Physical well-being
Emotional health
Other
Be 100% honest - What do you think is stopping you from reaching your goals? (The more specific you are here the faster we'll be able to get you clarity during our call together)
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Are you willing to invest $6,000 (over 6 months) to solve your weight issues once and for all?
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Yes
No
If money is an issue, may we contact you about our programs that are less expensive, are effective, but offer less support?
Yes
No
Phone
*
Click the "Submit" button below to find a time to meet with co-founders Helene and Penelope to discuss if the program is the right fit for you.
Submit
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