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8 Week Gut Health Body Transformation Casting
8 week probiotic & nutrition program for gut health centered weight loss. Results may air on TV and social media. This form will not be made public, but will be used internally in the casting process.
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Full Name
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Your answer
Phone
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Email
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Enter email again for accuracy
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Your answer
Current Age
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Your answer
Height
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Your answer
Current Weight (if you don't know take your best guess)
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Your answer
Goal Weight
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Your answer
Check all that apply
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Thyroid condition
High blood pressure
IBD/Crohns/Colitis
Type 1 Diabetes
Type 2 Diabetes
Heart attack/stroke
Cancer survivor
on medications for depression/anxiety
Bipolar/Schizophrenia
Regularly Constipated
Regularly Bloated
Autoimmune disorder/disease
Have had Gastric Bypass surgery
Known Food Allergies
Known Food Intolerances
None of the above
Other:
Required
List all current medications and supplements taking
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Your answer
What is motivating you to want to lose weight and how much weight would be your goal?
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Your answer
Are there things in life you avoid doing because of your weight? (please be specific)
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Your answer
Who would be most supportive of your weight loss journey?
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What types of fitness do you enjoy, if any?
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How would you describe your current eating?
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Anything else you would like to share?
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