Contact us

Contact us 

Dutton Park Weight Lose Challenge Club

Phone No.: 04 2510 2488

Email: healthybreakfast@live.com

Contact us If you want to know more, please fill in the form below, we will contact you shortly.

Name

First Last

Phone Number *

Email *

Where did you see our Advertisement :

Are you serious about wanting to lose weight? *

Yes  No  Not Sure

How Many Kilograms would you like to lose ?

1-5 6-10 11-20 more 1 Pound = 0.45 KG

Which of the following methods have you tried before to lose weight? *

---Select a choice--- Exercise Medication Eat Less Operation Liposuction Change of Diet More than one from the list Other None

What is/are the reason(s) why you would like to lose weight?: *

What do you want to ask us? *

Weight *

(Kilograms)

Height *

(cm)