Please note that all fields need to be filled out completely (including meals), or you will be asked to resubmit the form. In addition you must have completed both the Kickstart and Fillosophy online sessions before you can submit this form.
Describe what you typically eat for...
Do you feel hungry in between meals?
Do you take small bites and chew each bite well?
Do you avoid drinking fluids with your meals?
Do you eat a full serving of protein with every meal?
Have you experienced any vomiting, acid reflux, or other discomfort since your last adjustment?
Please indicate any other Slimband programs you're interested in
I would like to learn more about Slimband's Botox® or Juvederm® program.
I would like to learn more about Slimband's plastic surgery program.
I would like to recommend a friend or family member to Slimband.*
* As a Slimband patient you are eligible for a cash referral bonus.
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