Free Wellness Evaluation
We also offer FREE advice on your health and/or weight problems.
Please answer the following questions, so that we can better assist you
with your needs. All information you provide is strictly confidential.
you or a member of your family like to lose weight?
so, how much?
3 - 5kg
5 - 10kg
10 - 20kg
20kg & over
you have any health problems? Please fill in your problem, how long
you have had it & what you have tried.
Allergies : In the same way as you should not eat certain foods depending on your allergies please advise if you are allergic to any of the following:
Thank you for your responses. Please use the space below for any other
information you think would help us to assist you with your weight
We may have to contact you with questions regarding your
survey or, to fit a program to your needs. Please
provide valid information below:
Monthly affordable budget over a 6 month period? You will get a better result byusing less products consistently every day over a 6 month period.
What is your budget: R
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