Easy and simple weight loss

EASY AND SIMPLE WEIGHT LOSS
QUESTIONNAIRE

Hello Weight Loss Seeker,

Thank you for your interest in working with us!

I am exited to receive your completed questionnaire. Once I do, I will contact you immediately to schedule a one-on-one interview.

Once we have reviewed your questionnaire and conducted our interview, we will determine the next step to be taken.

To determine and understand your needs and concerns, and to find out your commitment to change, please fill out my brief survey below.

Thank you.

PROFILE

First Name
Email
Phone
Address1
Address2
City
State
Zip
If not listed above, please specify here:
Personal Fitness Goals & Objectives?
What are you currently doing to lose weight?
What should happen? What would you like to see happen?
What is keeping you from getting there? [Motivation? Injury? Health issue?]
What would you gain on a personal level if you accomplish your goal?
How many times are you currently working out and what are you doing?
Why are you interested in working with us?

Thank you for your time. I am looking forward to review your information and to speak to you in person.

In the meantime, please fill free to contact us if you have any questions.

Kind regards,

Stefan Aschan
Weight Loss Coach
AFFA, ACE, Reebok University, Naturopath
http://www.EasyAndSimpleWeightLoss.com