Weight Loss Study Pre Survey | Resona Health - Resonance Frequency Therapy

This weight loss program is unlike anything you have ever tried or even heard of in your life. For the next 30 days, we DO NOT want you to change our diet, eating habits, or exercise routine (except you must be hydrated for the therapy to work, 4 glasses of water in the preceding 4 hours before a therapy session). Stick to what you normally would do except use the PEMF device as instructed. If you lose weight, we want to be sure its due to the device and nothing else.

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone *

Date / Time *

Date

Time

Gender *

Male
Female

Age *

Weight in lbs. (completely undressed) *

The reason we are asking the following 2 questions below is our weight loss protocol is based on the assumption that weight gain is caused by insulin resistance. This data helps us conduct better clinical analysis. Thank You.

Have you been diagnosed with Diabetes? *

No
Yes – Type I
Yes – Type II

Enter your last HbA1c test result (if appropriate)