FREE Body Fat Analysis

4839 Leslie Street
Toronto, Ontario M2K 2J8
Phone: (866) 240-2281

* Required Fields:
* First Name:
* Last Name:
* Your Email Address:
* Phone:
* What is your primary area of concern?:: Hips and Thighs
Buttocks
Stomach
Legs
Back
Chest
Arms
Chin and Neck
Entire Body
* Choose which body shape best decribes you.:: I tend to store fat around my stomach and chest - Apple Shape
I tend to store fat in my lower body - hips, buttocks, saddlebags - Pear Shape
I tend to gain and lose fat evenly - Proportionate Shape
* How frequently do you exercise?:
* What is your current weight in pounds?:
* What is your height in feet and inches e.g. 5' 7''?:
* What is your age?:
* What is your weight loss goal?:
* Have you tried a weight loss program in the past?:: Yes
No
If you answered yes to the question above, which program did you try?:
* Are you currently on a weight loss program? :: Yes
No
If you answered yes to the question above, which program are you presently on? :
* What type of consultation would you prefer?:: Face to face at our office.
Telephone consultation.
Not interested in a consultation at this time.
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Adrian Woodrow, M.D. is committed to the prevention of disease and remains current in all leading related medical developments.
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