Welcome!
Thank you for your interest in the 12 Week Weight Management Program! I would love to get to know you better. Please fill out the following questions below before we dive in to the Program Crash Course.
First Name*
Last Name*
Email*
Practice / Hospital Name*
Role / Title*
Please choose all options that apply to your role:*
Inpatient
Outpatient (pre-operative)
Outpatient (post-operative)
Operating Room
What do you think your patients need help with the most pre or post-operatively?*
If time, money, and resources were available to you, how would you approach solving their needs?*
On a scale of 1-10, (1= not at all, 10= absolutely) how would you rank your interest in a Leadership position?*
Submit