Sign up now to lose 2-stone in 8-weeks...
Please choose your requirement (class/course/coaching)
Online Course - 199 GBP
Class Derby - 20 GBP Per Month
Class Burton - 20 GBP Per Month
First name and family name
Any name you prefer to be called
Address and Postcode
Mobile telephone number
Next of kin name and telephone number
Retype Email Address
Date of birth
Waist and hip size (inch)
(Females only) Dress size
Living with Partner
In a relationship
Number of children and ages, if any
What is your attitude to food
Why do you need Slim Brothers help
What did you eat yesterday
Where do you normally shop for food?
Marks & Spencer
None - someone else does it for me
None - eat at takeaway/restaurants
Diets tried before
Current exercise programme (30 minutes plus)
What is your 8-week goal
Do you have any health conditions
High Blood Pressure
Recently had surgery
Pregnant or have been in the last 6 months
Other health problem details (if any, and full details of any above conditions), any operations you've had and any medication you currently take
Do you have any special dietary requirements (vegetarian, vegan, nut allergy, etc)
Where did you first hear about us
Please tick below to confirm
I UNDERSTAND I SHOULD CONSULT MY DOCTOR BEFORE STARTING ANY NEW DIET, EXERCISE OR LIFESTYLE PLAN.
Please tick if applicable
I DO NOT want Slim Brother to send me slimming tips & news via SMS & email.
Digital Signature - Please write your full name
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