Serenity Weight Loss and Detoxification Program INTAKE FORM

If you have trouble viewing or submitting this form as shown belwor or click here to go direct to the form @  fill it out in Google Forms.

Serenity Weight Loss and Detoxification

INTAKE FORM: To save time, click here ENROLLMENT SITE and PROGRAM SCHEDULE to 
schedule your class and process enrollment. NOTE: If you were directed to complete this form 
AFTER enrollment, we do not need you to do anything else except provide the information below . 
Check you email for your 24-page DETOX MANUAL and the invite confirming your on-line BOOT CAMP.
Bring the DETOX MANUAL with you and please have it open so that you can follow along with your coach 
as she is speaking

    Summer Cleanse Starts weekly with the Blood Type Eating Challenge. Each seasonal cleanse progresses to the Parasite|Candida (Yeast) Cleanse, Liver Flush, etc.


    What is your current weight?

    Medical:

    •  

    Age and date of birth

    Height

    Weight @ age 18

    Healthy goal weight?:

    Name your top two food vices: (Check at least two, you may check more)

    • Serenity Weight Loss and Detoxification


      Our Web-formercial

      Serenity Weight Loss and Detoxification Program is the sponsor of Serenity Radio Network (SRN)

      Serenity Detox Web-formercial


      Name 

      Email 

      Address 

      Phone number

      Comments
Powered byGoogle Forms
This content is neither created nor endorsed by Google.
Report Abuse - Terms of Service - Additional Terms

Popular Posts