V Shred | Metabolic Assessment Session BROAD 20230113 TYP

1
What's your gender* This field is required.
Male
Female
2
What’s your biggest fitness goal in the next 90 days?* This field is required.
Lose fat
Build muscle
Get toned
3
What’s your BIGGEST motivation for getting in shape?* This field is required.
I want to look more attractive to others
I want to feel more confident in my own skin
I want to look amazing for an upcoming vacation/wedding/special event
I want to be healthier
I want to like what I see in the mirror
4
How many pounds/kilograms you want to lose in the next 90 days (if any)?* This field is required.
I'm not looking to lose weight
1-10 Pounds / 1-5 Kilograms
11-20 Pounds / 5-10 Kilograms
21-30 Pounds / 11-15 Kilograms
31-40 Pounds / 16-20 Kilograms
41+ Pounds / 21+ Kilograms
5
When was the last time you’re successful at losing weight, and what did you do?* This field is required.
I was tracking my calories
I was working with a personal trainer
I was on keto or low-carb diet
I haven't been successful at losing weight yet
6
How many diets have you tried in the past 12 months?* This field is required.
None
1 diet
2 different diets
More than 2 different diets
7
How often do you work out?* This field is required.
I don't work out yet
Once a week
2-3 times a week
4-6 times a week
More than 6 times a week
8
Do you tend to crave more sweet foods, salty foods, or both?* This field is required.
I crave sweet foods
I crave salty foods
I crave both sweet and salty foods
I don't have any cravings
9
Have you ever tried cutting carbs or doing keto? (Keto and low carb isn’t for everyone, we just want to know if you’ve been through any cycles of this type of diet plan because it can affect your metabolism!)* This field is required.
Yes
No
10
Have you noticed you get tired after eating meals?* This field is required.
Yes
No
11
What’s usually harder for you: Sticking to a diet plan or consistently working out?* This field is required.
Sticking to a diet plan
Working out consistently
12
What's your MONTHLY household income in USD?* This field is required.
Less than $2,000 per month
$2,001 - $3,000 per month
$3,001 - $5,000 per month
$5,001 - $8,000 per month
$8,001 - $10,000 per month
$10,001 - $20,000 per month
More than $20,000 per month
13
Are you willing and able to invest in our brand new V Shred Accelerator program if we can help you accomplish your physique goals in 90 days or less (guaranteed results, or your money back)* This field is required.
Yes, I can invest if there's a fit during the call.
No, I cannot invest right now.
14
Please share if you have any of the following conditions. This will help us determine if we are qualified to help you at this time (check all that apply. Your information will be confidential):* This field is required.
High Blood Pressure (untreated)
Asthma (severe)
COPD
Parkinson’s Disease
Dementia/Alzheimer’s
Motor Neuron Disease
Metabolic Myopathies
Chronic Obstructive Pulmonary Disease
Chronic Kidney Disease
Systemic Lupus
Cystic Fibrosis
Open Heart Surgery (post-op)
Torn Ligaments/Tendons/Tissues
Uncontrolled Tachycardia
Late Stage MS or other neuromuscular degenerative diseases
Spinal Stenosis
Schizophrenia
Undergoing Chemotherapy/Radiation
None of the Above
15
Hello, please type in your name down below.* This field is required.
First Name
Last Name
16
How old are you?* This field is required.
18-24
25-34
35-44
45-54
55-64
65+
17
Hey {name}! Nice to meet you. What's your email?* This field is required.
example@example.com
18
Last question: what's your mobile phone number?* This field is required.
19
This is your final step in submitting your metabolic assessment form. By checking this box, you are providing express written consent to receive promotional materials, including email, voice and SMS communication from V Shred. You have the right to revoke this consent at any time. To do so, please click the unsubscribe link in our emails, reply ‘STOP’ to any text message you receive from us. You also acknowledge that you are not required to provide this consent as a condition of purchasing any goods or services from V Shred.* This field is required.Privacy policy Terms and conditions
Yes, I acknowledge and confirm the terms and conditions above.
20
21
Final question, what's your mobile phone number?Please, do not add any "+" signs or "( )" between characters.
Country Code
Area Code
Phone Number
22
Metabolic Score
23
Income Tier
24
utm_term
25
utm_content
26
utm_source
27
utm_campaign
28
utm_medium
29
User Agent String
30
Hidden Box
31
Get Page URL
Should be Empty: