Healthcare Resources Request 
These resources are meant for healthcare professionals and their patients/clients to learn more about TOPS and healthy living. Please fill out this form by entering contact information and then choosing what and how many resources you would like sent. Once they are shipped, you will receive your resources within 1-2 weeks for the US and 2-3 weeks for Canada! Unfortunately, we do not offer shipping outside of the United States and Canada at this time.

*You will not receive these resources unless you fully complete this form.
Sign in to Google to save your progress. Learn more
Name *
Title (RN, Dietician, etc.) *
Company/Practice Name *
If you are not a healthcare professional but would still like these resources, explain what they will be used for.

Note: These are not free chapter meeting materials or for solely personal use, these are healthcare resources.
Full Address (street, city, state/province, zip) to send resources to *
Phone Number *
Email *
Powerful Support for Real Weight Loss and Lifelong Health Concise, thorough explanation of TOPS. Ideal for sharing with patients! *
Healthy Eating for Families Written for teens and their parents, grandparents and healthcare providers. *
Emotional Eating – Encouraging insights to recognize and resolve emotional eating issues, which can sabotage weight-loss efforts. *
Take Control of Diabetes with TOPS – Great information for anyone with diabetes or pre-diabetes. *
Any other comments/questions/concerns?
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report