Let's create a personalized plan for you.
We think weight is personal, so let's start by asking your name.
What's your first name?
Sex and hormones impact how our bodies metabolize food.
Gender
Female
Male
Intersex
How young are you?
Age Range
20s
30s
40s
50s
60s
70s
*Once you submit your answers, we’ll securely pass this info to your TrimLine Weight Loss Concierge to ensure your weight care path is safe and effective.*
What's your weight loss goal?
Weight Loss Goal
Lose 1-20 lbs for good!
Lose 21-50 lbs for good!
Lose over 50 lbs for good!
Any weight. I just want to feel better and healthy.
I haven't decided yet. I could use some guidance.
In every weight loss and healthy journey, there is a past, a present and a future (the future is bright!) 😎
Which of the following have you tried to lose weight in the past?
(check all that apply)
Past Efforts
Calorie counting / restricting
Cutting out certain foods
Using a "food philosophy" like keto, whole 30, intermittent fasting, etc.
Commercial weight loss programs like Weight Watchers, Jenny Craig, Nutrisystem, etc
Shakes and Meal replacements
Did we miss something? Type your answer here.
Past Efforts Other
By the way, we don't believe in deprivation, calorie counting, or crash diets here. 😌 We believe you can have your cake and eat it too. 🍰
How long have you been trying to lose weight and get healthy?
How Long Have You Tried
My whole life
Several years
6-12 months
Less than 6 months
I haven't tried to lose weight in the past (never tried dieting or exercise)
Tell us your main reason on why you want to lose weight NOW:
(check all that apply)
Why Now?
Health (physically & mentally)
It’s time to make myself a priority
Quality of life (more energy, active)
For my family/kids/grandkids
Appearance (clothes, confidence, pictures)
Another reason? Tell us about it.
Why Now Explained
Imagine yourself at your healthy goal weight…really SEE yourself there, what will change?
(check all that apply)
⚡ Imagine Goal Weight
I will fit into the clothes size I want
I will have more energy / do more
Feel more attractive / confident
Better relationship with my spouse/partner/family
Better eating habits for my children
My Physical Health (off meds, prevention, less joint pain, etc.)
My Mental Health (at peace, feel better about self, happier, etc.)
Do more with my kids comfortably
Imagine yourself at your goal weight, what is the first thing you want or will do?
Imagine Goal Weight Will Do
Using the scale from 1 to 10, right now, how important is your HEALTH?
(1 being the lowest and 10 being the highest priority)
How Important
Excellent. We are passing along this information confidentially to your TrimLine Concierge who will share with you, your personalized plan!
What's your email address?
*
What's your phone number?
*
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