The Weight Loss People - Application for Weight Loss Course

Tel: 08 456 80 80 08

Weight Loss

Courses

FAQs

Course Dates

How to Book

Please complete as much as you can of this application form. We will telephone you to go through it and ask a few questions and then we will be able to confirm your application, or ask you to give more information or consult with your doctor.

Once your enrollment is confirmed a £50.00 deposit is required; the balance of the course fee is payable ten days before the start date. An information pack with directions and registration details will be forwarded to you when the complete payment is received.

If for any reason or your tutor decides that the course is not for you during the first day then you will receive a full refund.

Application to Enroll

First Name:

Family Name:

Email:

Telephone:

When is the best time to call you?

Monday

Time:

Tuesday

Time:

Wednesday

Time:

Thursday

Time:

Friday

Time:

Address:

Postcode:

Date of Birth:

Height:

cms

What weight do you want to reach?

kgs

Over what period do you want to achieve this weight loss?

Where did you hear about us?

Please state your reasons for wanting to lose weight. This information will remain confidential between you and the Therapist; it will never be repeated or referred to regarding you personally during the course. It is however important that you identify why you want to lose weight once you start to take the time to think about this you may be surprised at the number of reasons you can find.

See the list of other peoples' reasons for a guide; then provide as many reasons as you can for why you want to lose weight.

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5.		6.
7.		8.
9..		10.

Are you taking any Doctor prescribed weight reducing medication?

If yes, how long have you been taking this medication?

Have you tried other methods of weight loss?

if yes, please state which types:

Do you suffer from diabetes?

If yes, which type?

What medication do you take for diabetes ( if none please state NONE)

Are you taking or have you taken steroids in any form within the last two years?

Thank you. We will contact you and discuss your application. Please click here to view the Course dates and state a first and second choice of course.

The Weight Loss People

Hope Chapel, Curzon Road,
Ashton Under Lyne,
OL6 9LX
Tel: 08 456 80 80 08
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