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Debra Stefan
2022-07-14T03:20:04-07:00
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Readiness Questionnaire
Readiness Questionnaire
How much weight would you like to lose?
*
10 - 25 lbs
26 - 50 lbs
51 - 75 lbs
76 - 100 lbs
101 - 150 lbs
151 - 200 lbs
200+ lbs
300+ lbs
How tall are you?
*
Under 5'
5'1"-5'3"
5'4"-5'6"
5'7"-5'9"
5'9"-5'11"
6'-6'2"
6'3"-6'5"
6'6"-6'8"
6'9" +
How old are you?
*
18- 21
21-25
26-30
30-35
35-40
40-45
45-50
50-55
55-60
60-65
65-70
70-75
75-80
80-85
85 +
How motivated are you?
*
Not sure
My greatest priority
Depends on other people
Have you reviewed Debra Stefan Fitness FAQ page to understand the services provided?
*
Yes
I confirm and acknowledge that I have reviewed all of the FAQs and Terms of Service prior to submitting my application.
*
Yes
FAQ: https://debrastefan.com/weight-loss-retreat-faqs/ Terms of Service: https://debrastefan.com/weight-loss-retreat-faqs/
Do you have the time and resources to devote to making a lifestyle change?
*
Yes
Are you ready to make a commitment to attend a residential weight loss camp?
*
Yes
No, but I need at-home help!
Name
*
Email Address
*
Phone Number
*
Please Indicate Time Zone
*
Signature
*
Schedule a talk with Debra:
https://calendly.com/debra-stefan
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