Interest Form | Thera™ Wellness Weight loss Program

LET’S GET STARTEDDijana Gregurec2023-03-27T10:47:18+00:00

	If you are human, leave this field blank. Name * Now, tell us a bit more about yourself, how old are you? * What’s your height? (ft/in) * What’s your current weight? (Ibs) * What’s your goal weight? (Ibs) * Now tell us more about your GOALS: * Lose weight Make healthy changes to your diet Get fit Improve the way you look Improve the way you feel Get healthier Other (state) Describe "other" from above. What is the weight you have had for the longest period in your life? * How much weight do you expect to lose in one month? * When do you want to start your transformation process? * Right Away In the near future Leave us your zip code: * GREAT! Let’s make it happen! Leave us your email: * Confirm Email: * Let’s continue to learn more about your eating and exercising habits. Do you like to engage in any physical activities? * Yes No Which activity? Tell us more about your eating habits: Do you eat breakfast? * Yes No What time do you usually eat dinner? * Do you drink sodas often? * Yes No Do you drink alcohol often? * Yes No Do you eat sweets often? * Yes No Do you have any food cravings? * Yes No Sometimes Are they cravings for: * Sugar Salty snacks Do you prefer eating: * Fruits and vegetables Meat Dairy products Pasta and bread Sweets Do you eat between meals? * * Yes No Sometimes Do you eat before going to bed / at night? * Yes No Sometimes Do you eat when stressed? * Yes No Sometimes Do you have any food intolerances? * Gluten Lactose Milk products Eggs Other Which other food intolerance you have? Let’s learn more about your life-style choices: What is your motivation to start the weight loss program? * I don’t like the way I look I want better health I want better work and / or social opportunities Other I want to reduce medications or prevent health issues I want to fit in my clothes and not buy size up I want to wear more stylish clothes I want to look more attractive to my partner and / or in general I want more energy I want to look better / feel better I want more mobility and vitality I want to look better for the upcoming vacation (event) I plan to attend I want to wear smaller size clothes than I currently wear I want to feel more confident socially, professionally, personally Other Other: Have you tried any other weight loss program(s) in the past? * Yes No Sometimes Which one? Why the program didn’t work? Your level on interest to lose weight: * 1 2 3 4 5 Please list your level of motivation from 1 to 5, 1 being the smallest and 5 the highest level of motivation. Are you ready for the life style changes to be the part of the program * 1 2 3 4 5 Please list your level of motivation from 1 to 5, 1 being the smallest and 5 the highest level of motivation. How confident are you in losing weight this time? * 1 2 3 4 5 Please list your level of motivation from 1 to 5, 1 being the smallest and 5 the highest level of motivation. How confident are you that you will keep it off this time? * 1 2 3 4 5 Please list your level of motivation from 1 to 5, 1 being the smallest and 5 the highest level of motivation. Do you anticipate family / friends support? * 1 2 3 4 5 Please list your level of motivation from 1 to 5, 1 being the smallest and 5 the highest level of motivation. Do you feel you need the support to start and / or succeed through the weight loss program? * Yes No Maybe I’m not sure reCAPTCHA is required.

THERA WELLNESS™
A Galaxy Health Technology Brand

That was the easiest way I have ever lost weight! I’m astonished with the change I experienced in my eating habits too.

Jonathan B., NY

I lost 14 lbs in 4 weeks! I was amazed every morning seeing the numbers on the scale going down. I also learned about food sensitivities I didn’t even know I had. I am now free from food sensitivities, and the inflammation pain in my knees and joints is gone, too.

Diana G., MD

I lost 5 lbs in my first week of this program! I am re-energized and love my knew attitude to foods, and enjoy my healthy life-style now.

Cristina S., CT

Notice: THERA WELLNESS™ is a non-medical wellness device/technology. The statements described on THERA WELLNESS™ websites and other materials have not been evaluated by the Food and Drugs Administration. This technology (device) and its use is not intended to diagnose, treat, cure, mitigate or prevent any disease or condition. If you have a medical condition or concern, please consult an appropriate health care professional.

LEGAL DISCLAIMER: THERA WELLNESS™ WEIGHT LOSS program achieves an average weight loss of ½ pound a day, and a total of 6-14 Lbs. in the first 4 weeks for women; and up to 1 pound a day, and a total of 10 – 20 lbs. during the first 4 weeks for men, that is, if the program is followed in all its details.

These average weight loss results are statistics based on 12 years of experience working with clients in Europe. Individual results will vary, depending on the individual goals, adherence to the program’s protocol, and barring any unforeseen condition which may impede a person’s ability to lose weight.

PRIVACY POLICY | Book an appointment | Blog