Home
About
Services
-Aesthetics
-Esthetician Services
-Skincare Products
-Microneedling
-Women’s Health
-Men’s Health
-Direct Primary Care
-Spray Tan
-inBody
-Health Coaching
-Weight Loss
-Medication Refill Request
-Weight Loss Resources
-Stopped Losing? Request Help!
Memberships
-Toxin Membership
-Weight Loss Membership
-Beauty Credit Club
Contact
Book Now!
Stopped Losing? Request Help!
← Back
Your request has been sent
We know weight loss plateaus are hard, but we’re here to help! Someone will be in touch soon to help you through this!
First Name
*
Last Name
*
Email
*
Date Of Birth (YYYY-MM-DD)
(required)
Beginning Weight
(required)
This is the weight you started your journey
Current Weight
(required)
This is the weight you just got from your scale
How many weeks have you been at your current weight or not losing?
(required)
Weeks at current weight
Are you tracking your daily calorie intake?
(required)
Yes
No
Sometimes
Do you know how many calories you should eat each day to lose 1 pound per week?
(required)
Yes
No
Roughly how many calories do you consume each day?
(required)
What lifestyle habits have you recognized as unhealthy? Have you changed them?
(required)
How many grams of protein are you eating daily? Your tracking app will tell you!
(required)
Have you been managing your constipation?
(required)
Yes
No
How many ounces of water are you drinking daily?
(required)
Have you increased your body movement daily? If so, what have you done?
(required)
Anything else you’d like us to know?
By submitting this form, you confirm that you are a current patient under our care and are seeking support with your weight loss progress. You understand that adjustments to your treatment plan may require clinical review, and you consent to being contacted by our team to discuss next steps.
Submit
Submitting form
Δ
