The Superstar Health Show Interview Request Form

The Superstar Health Show Interview Request Form Instructions

Read each question and type your answer in the space provided. After completing the form and re-checking your email address, click the “Send Form” button at the bottom. Please keep in mind that interviewees will be chosen based upon the answers provided. The better and more honest your answers are, the more likely you are to be selected.

EMF Web Forms

Your Name*
Your Email Address*	Please re-check for accuracy
Why do you want or need to lose weight?*
How long have you been trying to lose weight?*
How much weight do you want or need to lose?*
How is your weight affecting your life?*
Are you currently dieting or taking pills to lose weight?*
How would your life be different or improved if you could start losing weight now? How would you feel?*
What has stopped you from losing weight in the past?*
What do you think you need to do to lose weight now?*	Please re-check your email address before clicking the “Send Form” button