My HCG Diet Survey First Name * Email * Age * Please select an age18-2425-3435-4445-5455-6465-7475 Gender * Please select a genderFemaleMale I Would Like to Lose * Please select an i would like to lose10-20 pounds20-50 pounds50-75 pounds75-100 pounds100 My Goal Weight Is * Please select a my goal weight isPlease round to the nearest110125140160180220 What Phase Are You Currently On? * Please select a what phase are you currently on?Phase 1 – Prepping for dietPhase 2 – The HCG PhasePhase 3 – StabilizationPhase 4 – Maintenance My Favorite Recipes Feature (Choose One) * Beef Chicken Egg Cheese Vegetarian Fish Crab or Lobster Shrimp What Types of Features or Articles Would You Like to See? My #1 Diet Challenge Has Been * Hunger Family Temptations Stabilizing (Phase 3) Where Did You Purchase Your Copy of The HCG Diet Gourmet Cookbook? * Amazon Barnes & Noble My Doctor/Health Food Store HCGRecipes.com Other I do not own the cookbook Personal Notes & Comments
