Let’s start with where you are now
Date of birth
*
Your current weight
*
Your height
*
Gender at Birth
*
Female
Male
How would you rate your current level of sexual desire?
*
Very high
High
Moderate
Low
Very low
How often do you experience difficulties with sexual performance?
*
Always
Often
Sometimes
Rarely
Never
Sexual goals and expectations
*
Increase sexual desire
Improve erectile function
Enhance orgasm intensity
Considering our program is out-of-pocket, as insurance DOES NOT cover it, how committed are you to invest in your weight loss goals?
*
I'm fully committed and willing to invest.
might need some financial options or a payment plan.
I'm not ready to invest at this time.
First Name
*
Last Name
*
Email
*
Phone
*
I agree to
terms & conditions
provided by the company. By providing my phone number, I agree to receive text messages from the business.
