Through a simple health evaluation, we can recommend product packages that fit your unique needs and interests. We make it easy for you to get the right products for your family, so you get the best results.
Check out our website at www.fuzzyslippersforever.com

Barbara Helms-Bot     763-537-3918       bhelmsbot@msn.com

Survey Form
 
Thank you for your interest in scheduling an appointment. Please answer the following questions so that I may be of better service to you. Thank you!
Please complete this survey. Thank you!
Name:*
Phone:*
E-mail:*
We will contact you by email with a tentative date and time for your
appointment. Please respond promptly so your appointment can be confirmed. Thank You!
Specify days and times your are available during our office hours: M-F 9:30 a.m. to 2:30 p.m. Central Time.*
Please select the statement(s) that applies to you and answer the questions that match your situation.
I have followed the steps on the "Rescue Me" or "Weight" program outlined on your website and am requesting a follow-up phone appointment with you to support my program.
I am interested in scheduling an appointment first.
I have a specific health condition and am interested in learning about the services of the Nutritional Consultant you refer.
If you could wave a magic wand, list in order of priority from highest to lowest the top 3 areas of most concern to you:*
Please list a typical day's diet, including: breakfast,lunch, dinner, snacks, and fluids
Please describe any exercise you do such as cardio and/or weights. Include duration and frequency.
3. Are you ready to make some changes now?*
Yes No
Additional Comments:

 
* Indicates field is required.