Apply For Your Free Consultation

After completing your application, you'll be directed to our calendar to schedule a complimentary 45-minute consultation with Amanda Chinkan!

First Name *

Last Name *

Email *

Phone Number *

1. To confirm, you are filling this out because you KNOW there is more your body can do and you are ready to take the steps necessary to change your body for good! *

Yes! I'm ready to change my diet and lifestyle so I can be healthier and live a life not controlled by symptoms!

No, I'm not ready to make massive change and am leaving now.

2. Which of the following best describes your goals for your health? *

I want to lose 20-40lbs

I want to lose less than 15lbs

I want to get rid of symptoms that are holding me back in life

I want to change my diet to be healthy for ME

I want to understand my body's real needs

I want to learn how to break free of stress eating and binging

3. What makes you interested in this type of lifestyle change? *

My symptoms are so bad that I can't take it anymore

Doctors helped me a little, but I have not fully gotten control

I'm tired of feeling like crap

I want to make changes so the people I love can have the best version of me

I know I can get my weight under control without having to resort to drugs, I just need help to learn how

4. Be 100% honest: What do you think has held you back from achieving your health goals until now? *

5. Do you have a significant other or valued friend who helps you make decisions and should be on this call? *

No, I make all my own decisions and don't need others opinions

Yes, I'll be sure to book a time when we can both be on the call

6. Once you click "Submit" you will be able to schedule a call with our team. Will you 100% be able to make the time you choose? We do not reschedule no-shows. *

Yes - I will stay 100% committed to the time I choose

Maybe - I'm not sure if I'm serious.

Where did you hear about us? *

If you selected "Friend/Family/Coworker," please type their first and last name below so we can send them a free gift!

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