HCG Des Moines Consultation Request Form
Thank you for taking the time to complete our online questionnaire. We understand that it takes real courage to discuss something so personal and we are honored that you're willing to discuss it with us.
Please take a few minutes to complete the information below as honestly as possible…there are no wrong answers.
Once we receive your completed form, we will be contacting you by phone to schedule your free consultation and see if working together would be a good fit for you.
What is your current height, weight and desired weight?
When it comes to your weight, what would you say is your biggest challenge?
What have you tried to do to resolve your weight issue?
If you don't deal with this now, what do you think the impact will be in another year? 5 Years?
What would your life be like if you were able to successfully lose the weight you want AND be able to maintain it?
How committed are you to losing the weight you want to lose?
I'll Do Whatever It Takes
If you were certain that you would be able to lose the weight you want and keep it off, how much would you be willing to invest in a 6-12 month comprehensive coaching & mentorship program that will help you get what you want?
$500 - $1,000
$1,000 - $3,000
$3,000 - $6,000
$6,000 - $10,000
Do Not Fill This Out