Qualify for Skinny Minnie Weight Loss Program

Ready to Rock Your Weight Loss Journey?

Number of Trips Around the Sun (Age):

Sky-Scraping Height (in inches):

Gravity’s Best Friend (Approximate Weight in pounds):

Mission Briefing: Are you currently doubling as a supermom (Pregnant/Breastfeeding)?

Yes
No

Let's Talk History – Have You Ever Danced With (check all that apply):

Medullary Thyroid Cancer
Multiple Endocrine Neoplasia Type 2
Type 1 Diabetes
Pancreatitis
Kidney Failure or Transplant
Gastroparesis
Hepatitis or Liver Disease
Active Cancer
Current Radiation or Chemo Treatments

Are You Ready to Kick Some Weight-Loss Butt?

Heck, Yes!🚀
Still Thinking🤔

BMI: ___
Mission Status: ___