Do you qualify for the HCG Diet?

Take the questionnaire below to see if you qualify for the HCG Diet.

We will be in touch with you based on the information provided. Thank you!

Name *

Name

First Name

Last Name

Email *

Phone

(###)

###

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Question 1 *

Have you tried dieting and are not able to lose weight?

Question 2 *

Have you been working out without results you want?

Question 3 *

Have you had labs run to assess the health of your hormone including thyroid assessed?

Question 4 *

Are you experiencing GI symptoms including indigestion, gas, bloating, diarrhea or constipation?

Question 5 *

Have/had any of the following: Active cancers, kidney failure, gall bladder and/or liver disease.