Sign-Up Form for Skinny Maverick
Sign-Up form to become a client of Skinny Maverick. Please make sure to fill in all required fields.
Your Name *
Your Surname *
Your e-mail address *
What is your Birthdate? *
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Your City (Where are you based Geographically?) *
What is your age? *
What is your exercise level? *
Do you suffer from any health conditions? If yes, please specify. *
Do you take any medicine? If yes, please specify what medicine and for which condition. *
What is your relationship status? *
Do you have children? *
What diets have you previously tried? *
Do you want to lose weight for the sake of losing weight, or do you want to lose weight for better health? *
Why do you think you are failing or struggling to improve your health? *
Your Contact Number *
Choose your Coaching Payment *
Disclaimer:
All information is for education only, and is not to be substituted as sound medical advice. We can help you on your path to great health with many benefits, we are not doctors or professional healthcare practitioners. We can refer you to the right people if that is what you require.  Never disregard the advice of your registered medical professional, or delay in seeking it because of something you have read on our website or because of something said to you by our coaches. Please consult with your registered healthcare practitioner before making any changes.  Skinny Maverick does not assume any responsibility for any actions taken by any parties.
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