How interested are you in losing body fat?
Not interested Somewhat interested Very interested Extremely interested
What do you value most in a weight loss program?
Quick results Painless method No downtime Long-term effects
How soon do you want to see results?
Within a week Within a month Within three months No rush
Do you prefer at-home or in-clinic treatment?
At-home In-clinic No preference
What is your preferred method of consultation?
Phone call Video call In-person Email
All set, how can we reach you?
Name
Email
Phone
(Details here)
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