Thursday May 15, 2008



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Sign Up

 


In order to join our weight loss program, please complete the patient registration form below. If you have any questions about registration or program details, you may contact our office at (813) 973-2261, during our normal business hours. You may also contact us electronically, at any time.

First Name
Last Name
Middle Initial
Address (for shipping)
Apt, Rt
City
State
Zip
   
Phone
Email
Re-Type Email
   
Age years old (young)
Weight pounds
Height inches (example: 6 feet 2 inches = 74 inches)
Waist inches (measure at your belly button)
Hips (females only) inches (measure at the widest part of your hips)
Gender
   
How much weight do you want to lose? pounds
What is your reason for wanting to lose weight?
What is the most weight you have lost, on any program? pounds
   
Plan prices

The myTimeToGetSlim Weight Loss plan is a comprehensive fat burning system. Each plan is designed for your individual body profile, and is designed to keep you in fat burning, 24 hours per day.

  • With the myTimeToGetSlim Weight Loss plan you will receive:
  • The GetSlim Program Kit
    The customized kit contains
    (a) the full body purification system, which is based upon your individualized body profile,
    (b) a 3 month supply of the 100% organic whole food supplements that your body type requires and
    (c) our copyrighted plan details
  • Secure access to the myTimeToGetSlim body profile analysis, patient activity center, daily food logs, progress tracker and communication access to the GetSlim Weight Loss team
  • One (1) month of professional one-on-one weight loss coaching services with our weight loss physician - the physician will personally review your progress each week and advise you on how to make any necessary changes.

I agree to purchase one GetSlim Program Kit and further agree to the terms of the myTimeToGetSlim Weight Loss plan.
Price$249 (one time fee)

After my initial one month of weight loss coaching services have expired, I agree to optionally subscribe to the professional weight loss coaching services and agree to the terms of use of the weight loss coaching services.
Price $59/mo

Promotional code (Discounts will appear on checkout)

 

Your agreement to use the myTimeToGetSlim weight loss plan, and optionally subscribe to our professional weight loss coaching services

This agreement forms the entire understanding between you and myTimeToGetSlim.com.

Upon signup, we will ship to you a customized GetSlim Program Kit. Within the kit there will be an adequate supply of purification and support products to last you for approximately three (3) months. You may purchase refills of your support supplements as needed. In addition the price of the kit also contains one (1) month of professional weight loss coaching services, administered by our weight loss physician. The GetSlim Program Kit is non-refundable and may not be returned to us for any reason. However if during shipping or handling, some of the contents became damaged, we will promptly replace the damaged item(s), at not cost to you.

Professional weight loss coaching services are purchased and subscribed to on a monthly basis. All billing is done via credit card. You must give us at least 30 days notice of your intent to cancel the weight loss coaching services. There are no pro-rata refunds or returns allowed for this service. Also consultations are limited in scope to weight loss on the myTimeToGetSlim plan. Also communications with our Physician is done via the myTimeToGetSlim.com web portal. Therefore you must have internet access to use this service. Further we are not responsible for any failure that you might have in accessing the internet.

You further agree that our liability to you in any way does not exceed the cost of the program that you have paid us for. THIS MEANS THAT IN NO WAY WILL WE BE HELD LIABLE FOR ANY DAMAGES. THERE ARE NO WARRANTIES, EXPRESS OR IMPLIED, BY OPERATION OF LAW OR OTHERWISE, REGARDING OR RELATING TO ANY SERVICE OR PRODUCT THAT MAY ARISE AS A RESULT OF YOU USING THE MYTIMETOGETSLIM WEIGHT LOSS PROGRAM. We will not be held responsible acts outside our care reasonable control. We will not be responsible for natural acts or acts of nature or negligence of any third party.

Further we recommend that if you are a high risk patient that you first check with your primary care physician (or trusted healthcare provider), prior to starting the myTimeToGetSlim weight loss program.

Finally any disputes that may arise out of this relationship, the parties agree to make reasonable attempts at dispute resolution. This may include dispute mediation and or arbitration. Should the parties not be able to reach an agreement and the matter is determined to be ripe for a court of law or equity, then the parties agree to have the matter heard in Pasco County, Florida. In which case, Florida law and Law of Florida rules of civil procedure will enure. We reserve the right to change jurisdiction due to counsel availability and other logistical events.

This contract was generated and signed electronically and comports to the electronic signing requirements by the Uniform Electronic Transactions Act.

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