Are you ready to transform?

Well... let's see!

In order to qualify to be 1 of the 10 people that will receive my Smoothie Handbook Weight Loss Program, you must answer the questions below. Your answers will show me what solutions need to be covered in the program. Please note that the information contained in my program should not replace your doctor's advice.

Thank you for your time! This should take only a few minutes.

Happy Answering!


P.S. Remember... not everyone will be chosen.

P.S.S. All of your information will be kept confidential.

First Name*
Last Name
E-mail Address*
Want to lose:*
Are you on a
special diet?
Please explain:
Do you have any medical problems currently? (Optional)
What type of junk food do you crave most?
What has kept you
from losing weight
in the past?
In which format would you prefer to learn about weight loss?
Ebook Course
Video Presentation
Live Webinar (Online Meeting)
Group Coaching
One-on-One Coaching
What smoothie flavors
do you LOVE?
Are you ready to
transform your life?
YES! I am willing to change the bad habits that got me where I am today!

Please enter the word that you see below.