Check fields, test, then upload. Change siz5ma-gil.cgi at the same time, perhaps saving old for a bit. Unicity Info Changing Beliefs EFT

	Free Weight Loss Newsletters
Daily Bites - Tips on EFT & NLP for Weight Loss Bits & Bites: Newsletter for People who Chew

Site Map

Unicity for Weight Loss & Reducing Cholesterol

Health Assessment Request

First Name: Required
Last Name: Required
E-Mail Address: Required	(Format: yourname@somesite.com) Your E-mail address is safe - See Privacy Policy
Telephone:	For 10-min consultation, please provide telephone
State or Provence:
Time Zone:


	What is your state of health now? Do you or does someone you know have any of the following: Overweight (Obesity) High blood pressure (Hypertension) High cholesterol (Hyperlipidemia) Out of control blood sugar (Diabetic or Pre-diabetic) Polysistic Ovary Syndrome, Syndrome X or Metabolic Syndrome Other health concerns (please list below in comments box)
	I'm primarily interested in losing weight Yes
	Are you presently on a special diet due to a health condition such as allergies, diabetes or other? Yes No
	Would you

Bits-n-Bites, Newsletter for People Who Chew
	Get OneMoreBite's Bits-n-Bites, the "Newsletter for People Who Chew," and/or The Daily Bites, lessons in using EFT for weight loss. Check below to join either e-mail list.	Your E-mail is safe. Your privacy is guaranteed
	Bits-n-Bites: The Weight Loss Newsletter for People Who Chew Daily Bites (Lessons in using EFT for weight loss
	Add any comments or questions in the following area:

Kathryn Martyn Smith, M.NLP EFT Weight Loss Coach

Using NLP & EFT to
End the Struggle With Weight Loss

210 NW 78th Street
Vancouver, Washington 98665
1-360-450-3907 | 1-904-369-1391 Fax
Contact Me