BEFORE you pay your coaching fee, please fill out the form below.  Once ProHealth Diet receives your form,  you will immediately be prompted to go to the next step, which will be filling out the mandatory Health Profile.     This is an easy process and can all be done online.  We just need to make sure we know your current health conditions so we know how to help you the best! 

The approval process is typically a very quick and easy process unless there are major medical issues needing to be thoroughly reviewed by the supervising Doctor.  If this happens please allow 24-48 hours for review.

Congratulations on taking an important step into your HEALTH future!

We are excited to help you reach your weight loss goals!  It's what we do!


Now let's get started... Take a few minutes to fill out this form:

How did you hear about the ProHealth Diet?:
Your Name:
Phone #:
What is your approximate CURRENT weight?:
What is your GOAL weight:
Where in the United States are you located:
On a scale of 1-10, how ready are you to lose your extra weight?:
Do you have a special request for which Coach assists you? If so, who?: