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Restoration Thyroid Nutrition Application
Name
Phone Number
Email
Where are you located?
What's the #1 goal you would like to accomplish in the next 4 months? What do you want to change about your lifestyle, food choices, etc?
What have you tried in the past that has worked for you? What have you tried that has not worked for you?
What has kept you from reaching your goals?
If you were able to heal in 4 months, what would that look like?
Please list 1 day of meals below. List everything from what time you eat, what you eat and how you feel.
How committed are you to healing right now? 10 being the highest.
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Knowing that our 1:1 program will help you [RESULT/OUTCOME], how ready are you to make an investment of $4,999 (payment plans available) at this time?
I am ready, send me the link!
I am ready but have a few questions first.
I am not ready to commit at this time.
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