Serenity Weight Loss and Detoxification Program INTAKE FORM

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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:


•  High Blood pressure and any meds
•  Diabetes, any meds?
•  Cholesterol , any meds?
•  Other: 


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)


•  Bread, muffins, biscuits, crackesr etc. like Oprah
•  Sweets: BAKERY GOODS
•  Sweets: Candies
•  SODAS and sweet drinks like iced tea
•  Alcohol: Beet, Wine, Jack Daniels, etc
• 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


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