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Name*
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Email*
Skype name (or mobile number if you don’t have skype)*

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How much weight you want to lose?*
What are your top 3 barriers to losing weight that I can help you overcome?*
How much money have you spent so far on trying to lose weight or get fit?*
Include gym memberships, meal replacement shakes, diet books and anything else you consider relevant
Is there anything else you’d like to add you think is important?*