BodyTrim Online Application Form

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Thank you for your interest in BodyTrim Online. Please fill the application form below to get started. After receiving and reviewing your application, I'll send you a messagel to let you know if you're eligible for the programme or not.

First Name *

Last Name *

Email Address *

Please fill in the email address you check regularly

Your Phone Number *

Country of Residence *

Current Weight *

Goal Weight *

Gender *

Female

Male

Age *

Do you have any existing medical condition that will make it dangerous for you to exercise? *

Yes

If we were to meet 60 days from today, what has to have happened for you to feel happy with your weight loss progress? *

Since you know yourself better than anyone else, what would you consider the top 2 things that need to change or have to happen for you to get there? *

How many times do you currently exercise in a week? *

5-6 times

3-4 times

2-3 times

1 time

Rarely

How physically active is your job ? *

Very active, I'm on my constantly on my feet most parts of the day

Moderately active, I get up and walk every now and then

Very sedentary, I am sitting behind my desk most parts of the day

Considering your current schedule, can you make time to exercise for 30 minutes 4-5 times a week? *

Yes I can

No, I can't

I can, but I won't because I hate exercise

The programme is 100% online, do you know that? *

Yes, I know!

No, I don't want an online programme

On a scale of 1–10, how important is it for you to lose weight now? *

Not Important

Very Important

Do you have any questions for me?

Submit

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