Vitality 360 Scan
First Name
In order to feel your best, how much weight would you like to lose?
10-20 lbs
21-40 lbs
41+ lbs
How much of a priority is it to lose this weight right now? On a scale of 1-10 (1 = not important; 10 = extremely important)
1
2
3
4
5
6
7
8
9
10
The goals you'd like to achieve (mindset, physique, metabolic etc.)
What are the 2 biggest challenges that are getting in the way of you being able to lose weight and keep it off (e.g. sugar cravings, emotional eating, confusion about what to eat, etc.)?
The Synaptic Fit Fusion Pros Academy is for action takers, who can invest their time, energy and make a financial commitment to their health and weight loss transformation goals. Does this describe you?
No
Yes
Working together comes in different levels of investement. What are you comfortable with investing right now per month to solve this issue?
$1000 - 2000 per month
$2000 - 3000 per month
$3000 - 4000 per month
I don't have money to invest right now
Submit
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