		Monday February 6, 2012

Sign-up

Sign Up

In order to join the GetSlim Program, please complete the patient registration form below. If you have any questions about registration or other program details, you may contact our office at (813) 973-2261, during our normal business hours. You may also contact us electronically, at any time.

First Name

Last Name

Middle Initial

Address

Apt, Rt

City

State

Zip

Phone

Re-Type Email

Age

years old (young)

Weight

pounds

Height

inches (example: 6 feet 2 inches = 74 inches)

Waist

inches (measure at your belly button)

Hips (females only)

inches (measure at the widest part of your hips)

Gender

Female

Male

How much weight do you want to lose?

pounds

What is your reason for wanting to lose weight?

What is the most weight you have lost, on any program?

pounds

Yes, I am ready to get my Health & Weight back under control, I want to join the GetSlim Program. Please have a staff member call me to set an appointment.

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Back to prospect information

To schedule an appointment please call:
(813)973-2261
or

Chiropractic Healthcare Services:
Neck Pain Relief
Headache Relief
Back Pain & Stiffness
Disc Injury Care
Sciatica Pain Relief
Family Care
Preventative Care
Muscle Spasm Relief
Common Health Concerns

Automobile Accidents:
Personal Injury
Whiplash
Low Back Pain
Upper Back Pain
Disk Injury
Headaches
Numbness & Tingling
Sciatica
TMJ

Weight Loss:
Personalized Natural Weight Loss programs
We never use appetite suppressants, B12 shots, or any other drugs. You won't feel deprived. You will eat healthy everyday foods.
21 days to a slimmer healthier you.

Completely Natural & Certified Organic Remedies for:
High Cholesterol
High Blood Pressure
Balancing Blood Sugar
Balancing Hormones
GERD & Digestive Problems
Hot Flashes, PMDD & Women's Health
Healthy Support
Personalized Clinical Nutrition Programs
We offer Certified 100% Organic Whole Food Supplements

Massage Therapy Services: (LMT)
(MM Number: 17168)
Deep Tissue Massage
Relaxation Massage
Therapeutic Massage

Providing Chiropractic services to the residents of Quail Hollow, Lexington Oaks, Grand Oaks, The Oaks, Stagecoach, Saddlebrook, The Villages of Wesley Chapel, Brookside, Seven Oaks, Meadow Pointe, Wiregrsss Ranch, Boyett Oaks, Country Crossings, Country Walk, Lake Jovita, Pasco County, Wesley Chapel, New Tampa, Zephyrhills, Dade City, San Ann, Saint Leo, Land O'Lakes Odessa, Florida, since 1995.
Contact us: 27210 Foamflower Blvd., Wesley Chapel, FL 33544. (813) 973-2261

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