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Welcome To Desire
Online Consultation
Complete and submit a confidential online assessment form and we will accurately assess your needs.
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6 steps!
Step 1 of 6
My Gender
Male
Female
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Step 3 of 6
My Height
My Weight
Waist Size
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Step 4 of 6
When it comes to weight loss, my biggest challenge is:
Changing my diet and giving up the foods I love
Changing my diet and giving up the foods I love
Staying motivated to stick with my program until I reach my goal
Lack of support from family or friends
Making time for cooking
Making time for physical activity
Making time for cooking and physical activity
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Step 5 of 6
How often do you participate in physical activity?
5-7x/week
3-5x/week
1-2x/week
I do not participate in physical activity
I cannot participate in physical activity.
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Step 6 of 6
Medical History (Is there any):
Hypertension
Diabetes
Thyroid
PCOS/PCOD
Other
Any Other?
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Step 6 of 6
Personal Details
Full Name
Email
Phone Number
Age
Profession
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