Weight Loss Program Form

Please fill this form with all the details I need to know. Feel free to write as much as you want.

The more I know, the more I can help you lose weight while keeping the smallest details into consideration.

Thank you for trusting me.

Weight-Loss Program Registration

First Name

Birthday

Last Name

Phone

Current Weight (in Kg)

Height (in cm)

Do you have any injuries?

What are you struggling with the most? ( body area, exercise, endurance, strength, motivation)

Available Equipment

How did you hear about the program?

Please write ALL the questions you have here and I will reply to them all :)

Please upload your inBody here if you have one, or send it via email when you do.

InBody Upload File

Please upload "Before" pictures so I can track your progress. (Optional)

How:

Wear tight clothes. and take pictures from:

1. Front

2. Right and Left sides

3. Back

1. Front Image

Front image Upload File

2. Right and Left sides

Right side image Upload File

Left side

Left side image Upload File

3. Back

Back image Upload File

You will be directed to the payment link.