30 Days to Wellness Webinar Series

Name: 30 Days to Wellness Webinar Series
SKU: 5752
Price: 400.00 USD
Availability: InStock

400.00$

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Description

Cost includes:

Registration Fee
Weight Loss & Cleansing Kit
or
Cleansing Kit (for those not looking for significant weight loss)
Vegetable Broth
Shipping and Handling

30 Days to Wellness Registration

Greetings, from Dr. Watkins and The Watkins Institute! To join our next 30 Days to Wellness program, please complete form below with all required data. If you have any questions or concerns please email up at contactus@twiliving.com

Step 1 of 3

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30 Days to Wellness Registration Form
Dr. Watkins and The Watkins Institute invite you to join our awesome Lifestyle Change program. Over the next 30 days (4 sessions) you will be taught lifestyle principles that will help lead you to Wellness.
Name of Church / Group / Company (who referred you to the 30 Days to Wellness Program)?*
Name*
First Last Suffix
Date of Birth*

Date Format (mm/dd/yyyy)
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Enter Email Confirm Email
Phone*

30 Days to Wellness Goal, Barriers and Program Cost
Personal Health Goal for Program*
Perceived Barriers to Achieving Personal Health Goal*
30 Days to Wellness ($400 value discounted @ price below)*
Price: $250.00
Registration package including Cleaning Program and Veggie Broth) see product @ www.twiliving.com/30dtw
Current Health Status
Current Weight*
Please enter a value greater than or equal to 1.
Enter weight in pounds
Current Blood Sugar (If Diabetic)
Normal Blood Sugar range is between 70 to 100 mg/dL
Current Blood Pressure
Normal Blood Pressure range is 120/80
Current Pulse Rate
Total Cholesterol
HDL Cholesterol
Current Cardiac CRP
How many Fruits do you eat daily?*
How many Vegetables do you eat daily?*
How many minutes do you EXERCISE daily?*
How many cups of WATER do you drink daily?*
Current Diagnosis (e.g. Diaebtes Type I or II, Heart Disease etc.)
Current List of Medications
Current prayer pattern (e.g. Daily, Weekly or Other) and how often?

Potential Referrals to Program (Family, Neighbors, Coworkers etc.)*

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30 Days to Wellness Webinar Series

Description

30 Days to Wellness Registration

Step 1 of 3

30 Days to Wellness Registration Form

30 Days to Wellness Goal, Barriers and Program Cost

Current Health Status

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Welcome To The Watkins Institute of Living