Qualification form

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Email*

Enter your email Confirm email

Name*

Name Last Name

Country*

Phone / whatsapp (Please add your country code)*

How old are you?*

Describe your main problem with weight and how you feel about not getting what you want.*

How long have you had this problem?*

What is your main obstacle for not solving it?*

What is your financial commitment to achieve your goal?*

How important is it to you to achieve that goal?*

When is it convenient for us to call you (Costa Rica time)?*

Finally, from 1 to 10, how motivated are you to get what you want and change your life? (Being 1, I am not motivated, and 10, I am ready to take action now).*

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10

Please if you have anything else I should know. Write it here, remember we are here to help you.

If you have passed the selection process, a member of my team or myself will call you in the next few days.

Phone *

First Name *

Last Name

Email Address *

Main interest: *

Availability: *This retreat takes place in Costa Rica from March 23 to March 29, 2026. Are you available to travel during these dates?Yes, I’m availableNo, I’m not availableNot sure yet

Investment: *The retreat price starts at $4,000+ USD per person. Does this work for you?Yes, I’m ready to invest in my health and well-beingNo, this budget doesn’t work for me.

Consent *

Yes, I agree with the privacy policy and terms and conditions.

Please do not fill in this field.

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