Talk to us - HIIP

You're Invited to

Talk to Us

How can we help?

Complete the form below then schedule a time for your call in the online calendar.

Name*
First Last
Email*
Phone*
Zip Code*
ZIP / Postal Code
Age*
Gender*
Height (feet)*
Height (inches)*
Waist Circumference (inches)
Current Weight (pounds)*
Your Highest Weight as an Adult (pounds)*
How has your weight changed over the past 12 months?*
Were one or both of your parents overweight or obese when you were growing up?
At what age were you first identified as Overweight or Obese?*
How many times have you lost and regained 10 pounds or more in the Last Five (5) Years?*
How many commercial diet plans have you purchased in the Last Five (5) Years?*
Please describe your current dieting efforts*
Scroll Through List And Select ALL Diagnosed Conditions That Apply To You. (Use Control or Command Key to Select Multiple Items)*
What is your willingness to take action should your evaluation results indicate serious health risk?*
PLEASE NOTE: A Valid Email and Phone Number Are Required to Receive Your Phone-Based Score Review and Score Reports
- Send me emails & special offers
- Send me SMS appointment confirmations/reminders and communications (texting rates may apply)

Scroll Through List And Select ALL Health Conditions That Apply. (Use Control or Command Key to Select Multiple Items)
High Cholesterol
High Triglycerides
Irritable/Irregular Bowel
Acid Reflux
PCOS
Hyperuricemia
Sleep Apnea
Irregular Cycle/Infertility
High Blood Sugar/Prediabetes (Insulin Resistance)
Type 2 Diabetes
Depression
Brain Fog/Poor Concentration
Back Pain
Joint Pain
Osteoarthritis
Fatigue/Tiredness
Shortness of Breath Under Exertion
Poor Circulation
Edema/Swelling
Neuropathy
Gangrene
Previous Stroke
Fatty Liver Disease
Heart Disease
Gout
Gallstones
Endometrial Cancer
Esophageal Cancer
Gastric Cancer
Liver Cancer
Kidney Cancer
Pancreatic Cancer
Colorectal Cancer
Meningioma (Brain Cancer)
Multiple Myeloma (Blood Cancer)
Gall Bladder Cancer
Ovarian Cancer
Post-Menopausal Breast Cancer
Thyroid Cancer
NONE OF THE ABOVE