The Superstar Energy Clearing Method™ General Information 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 all information submitted is confidential and that you need to be as open and honest as possible to get the best results. The more honest your answers are, the more I can help you.


Your Name
Your Email Address Please re-check for accuracy

 

Why do you want or need to control your appetite?


How long have you been experiencing an
unmanageable appetite?


How is your appetite affecting your life?


Are you currently dieting or trying to lose weight?  If so, how long have you been trying?


Do you get sudden urges to eat at a particular
time of the day or week? If so, when does this
occur specifically?


Have you felt unusually winded, tired or fatigued lately? If so, when do you feel this way most?


Have you had any unusual headaches or feelings
of heaviness in your head? When did this occur
most recently?


How would your life be different if you had
control of your appetite now?

Please re-check your email address before clicking the “Send Form” button

 

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