Share Your Success

Have you lost weight on The Perfect 10 Diet?

Congratulations! We’d love to hear about your success! Fill out the online form and tell us your Perfect 10 weight loss success story.  You don’t have to be at your goal to be considered a success story.  We want to know how The Perfect 10 Diet has impacted your life.

If your story fits our needs, we’ll email you forms that must be completed and mailed back to us in order for your story to be considered for use on the website and in the media.

We look forward to hearing from you--and congratulations on your success with The Perfect 10 Diet!

 

Share Your Sucess Story
  1. What's your fullname?*
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  2. Your E-mail*
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  3. What's your age?*
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  4. Your height?*
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  5. Your "before" weight?*
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  6. Your "after" weight?
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  7. How long you have maintained your weight loss?*
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  8. How long did it take you to lose the weight?*
    required
  9. How I gained it:*
    required
  10. Breaking point:*
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  11. How I lost it:*
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  12. What tips and suggestions could you offer others?*
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  13. Upload Before Photo
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  14. Upload After Photo
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  15. May We Use Your Story and Photos on The Perfect 10 Website?*
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