Please Read the Following Statement: This website is not a free online weight loss service and DOES NOT provide free online meal plans or fitness routines to the general public. The Body Focus EZDietPlanner & Fitness Tracker™ software is available to you when you become a patient at our office. Please fill in the questionnaire below only if you are interested in a FREE face to face or telephone consultation with Dr. Sattele and someone from our office will contact you to schedule an appointment.


*  Required fields.

*  First Name:
*  Last Name:
*  Your Email Address:
*  What are your top health and fitness goals? (choose all that apply)
Lose weight Stop smoking Eat healthier
Get in shape Reduce stress Detox and cleanse your body
Improve overall health Reduce aches and pains Get younger, healthier looking skin
Additional Goals: (e.g. Lower cholesterol)
*  What are your primary areas of concern?
Buttocks Back Hips and Thighs
Stomach Chest Chin and Neck
Legs Arms Entire Body

*  Describe which body shape best describes you.
I tend to store fat around my stomach and chest - Apple Shape
I tend to store fat in my lower body - hips, buttocks, saddlebags - Pear Shape
I tend to gain and lose fat evenly - Proportionate Shape

*  What is your age?

*  How frequently do you exercise?

*  What is your height?
ft. in.

*  What is your current weight in pounds?

*  What is your weight loss goal?

*  Have you tried a weight loss program in the past?
Yes No
If you answered yes to the question above, which weight loss program have you tried?

*  Are you currently on a weight loss program?
Yes No
If you answered yes to the question above, which weight loss program are you on?

FREE Consultation:


*  What service(s) are you interested in consulting with Dr. Sattele about? (choose all that apply)
* Consultation Type


* Consultation Date
* Time


Please provide a number to reach you:

*  Phone:

*  At Which Office Would You Like To Be Seen?:

Cell Phone:

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Comments:
*  Terms of Service:
I have read and agree to the Terms of Service.

 

Use of this site is subject to our terms of service and privacy policy. This site does not provide medical advice, diagnosis or treatment. The information provided on this site is for informational purposes only and is not intended as a substitute for advice from your physician or other health care professional or any information contained on any product label or packaging. Always consult with a healthcare professional before starting a diet, exercise, supplementation program or before taking any medication. If you have or may have any health problems and are considering Dr. Sattele's Rapid Weight Loss Program or one of the treatments/procedures discussed in this site, you should consult further with a medical professional first. The products and claims made about specific products on this website have not been evaluated by the Food and Drug Administration and are not approved to diagnose, treat, cure or prevent disease.
 
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