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Thank you for contacting Reset Rapid Weight Loss. A member of our weight loss team will be in touch with you as soon as possible!

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(205) 855-3770

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Name *

Email *

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Phone *

Where Did You First Hear About Us? *

News Radio 105.5 WERC - JT

102.5 The Bull - Billy, Madison and Dino

103.7 The Q - Dino and Madison

Referral

Online Weight Loss Search

Facebook

We are not able to accept any of the following health concerns listed below into the weight loss program. Also, insurance does not cover weight loss programs. Please do not reserve a time if any of these apply to you. Sorry for any inconvenience! *

Take Daily Insulin

Vegan or Vegetarian

Active Cancer Treatment Patient

Pregnant or Breast Feeding

NONE APPLY TO ME

What is your age? *

Which of these common symptoms of weight gain do you have? (Most clients on our program report improvements in these health problems.) *

Low Energy

Low Self Confidence

Digestive Issues

Poor Sleep

Hormonal Imbalances

Joint Pain

Decreased Motivation

Brain Fog

NONE-Feel great, just need to lose weight.

How many pounds do you want to lose? *

10-15 pounds

15-20 pounds

20-30 pounds

30+ pounds

OtherOther

What is the #1 reason why you want to lose the weight? *

What is the most important factor you are looking for in a weight loss program? *

Fastest weight loss possible

Real Food (No bars, shakes or packaged food)

Client Support

Keeping the weight off

Cost of the program

PROGRAM: If you can budget $447 per month, for 4 months, you can afford our program. We do accept HSA. *

Yes, I can budget $447/month, for 4 months, to hit my health goals.

If you are human, leave this field blank.

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