Email Address*

Sign me up to the Newsletter

Name*

CMWL Program*

Accelerated / Accelerated Plus

LCD / Modified LCD

Appetite Suppressant

Doctor Name* Aazami, Hessam MD Abando, Alan MD Acker, Christine NP Ackerbauer, Kathleen NP Adam, Todd Adam, Tyler MD Adams-Pickett, Donna MD, PhD Addy, Nii MD Adebayo, A.T. MD Adler, Lester MD Afre, Getachew MD Agim, Onyinye MD Ahmed, Syed Bilal MD Ajayi, Adebowale MD Akers-White, Tania MD Akpamgbo, Jane-Frances MD Al Shami, Mahmoud MD Al-Shami, Mahmoud Alav, Faramarz MD Albertson, Lynn NP Aldridge, Martha MD Alexander, Angelice MD Ali, Irfana MD Alligood, Tannis MD Alqulali, MD, PhD, FACOG, FAACS, Mona Aman, Paula PA-C An Pang, Chieng MD Anderson, David MD Andrews, James MD Anekwe, Chika MD Anistranski, Joseph MD Anyanwu, Jovita MD Arden-Cordone, Mary MD Ariza, Carlos MD ArroyoDiaz, Richard MD Arzumanova, Karina Asbery, David MD Ashford, Melvin MD Ashley, Robert MD Askari, Ruhi MD Atkins, Amy CRNP Attai-Biedebach, Alina PA-C Awadallah, Bahaa MD Aycock, Charles MD Aylor, Brad MD Azimi, Umayr MD Aziz, Asif MD Aziz, Asif MD Azizad, Masoud MD Babalola, Adejoke MD Babich, Paula Bahtiarian, Gregory DO Baig, Mirza MD Baker, Joseph MD Baker, Sharifa MD Ballaro, Joseph MD Bankole, David MD Bankston, Dawn MD Barad, Anjana MD Barnes Wells, Tara NP Barnett, R. Kyle MD Barniv, Charles MD Bartlett, Neysa DO Bataskov, Karrie MD Becerra, Elizabeth MD Becker, Sam MD Beebe, Christian MD Bennett, Bisona FNP Bereliani, Arash MD Berger, Marc MD Berger, Rodney MD Berhane, Leah MD Berklund, Hilari PA-C Bethel, DNP, APRN,, Tamara FNP Bhattarai, Muna NP Bishop DNP, Janis Black, Ellen MD Blank, Benjamin MD Blank, Martin MD Blum, Richard MD Bock, Lorraine DNP, FNP-C, ENP-C, FAANP Bolinger, Shannon PA-C Borgella, Joel MD Bornfreund, Jonathan Bottiglieri, Thomas DO Boutros, Maged MD Bowen, Bruce MD Braun, Nohl MD Brennan, Margaret MD Bristol, Brian NP Brooks, Delisa Brooks, Delisa APRN, FNP-C, PMHNP-BC Brooks, Marlon MD Brown DNP, WHNP-BC, Tracy DNP Brown Jr, Leon MD Brown, Joshua MD Brown, Lynn FNP Bruning, Kara NP Bruno, Robert MD Bryant, Nilah NP Burdeaux, Richard MD Burford, Gerald MD Burk, Charles DO Burke, Margaret MD Bushaw, Andrea WHNP Butler, Alisa FNP Byard, Stevie PA-C Cain, Robert MD Calcut, Terry MD Campbell, Joseph MD Capps, Marlene MD Carreno, Jacqueline MD Carreon, Melanie MD Castro, Irma MD Chadwick, Brian MD Chambless, Cynthia MD Chan, Colin MD Chandrasekaran, Aparna MD Chang, Norman MD Chen-hah, Marian MD Choi, Caroline MD Choi, Edwin MD Choudhry, Abdul MD Christenson, Elizabeth PA-C Chuback, John MD Citti, John MD Clarke, Ronald MD Clarke-Bennett, Karen DO Clarkson, Kathryn NP Claunch, Jere PA-C Cohn, Mitchell MD Collins, Cynthia MD Collins, Matthew PA-C Compton, Alise NP Conliffe, Mark DO Conroy, Maureen DO Cook, Lauren PA Coppock, Steven MD Corbett, Judy MD Cortez, Olga MD Cote, Cynthia MD Cottam, Korin MD Council, Lindsey FNP Coussons, Herb MD Cowan, Mia MD Crisan, Liviu MD Crosen, Kanina NP Cruz, Marilou MD Culley, Brian NP Culver, Sonya DO Cummings, Germaine MD Cunningham, Kirstie MD Curry, Mary FNP Curtis, Alan NP Cutler, Christopher MD Dagan, Tal MD Daly, John III DO Dameron, Andrea DNP, APRN, FNP-BC Danon, Joseph MD Daramola, John MD Das, Deepak MD Daub, Denise MD Davidson MS, RDN, LD, Lacy Davies, Kim MD Dayson, Don MD de Beixedon, John MD DeBaptiste, Celeste MD Dedinsky, Brian MD Dekeyser, S. Dianne MD del Castillo, Francisco MD Desai, Guatam Desautels, Steven MD DeSilva, Pamela MD Desir, Deborah MD Devane, P. Todd MD Devenport, Lisa MD Diaz, Alan MD Diaz-Jimenez, Jose MD Dietzgen, Patricia DO Diffine, David MD DiGiovanni, Maria MD Dittrich, Richard MD Do, Doan MD Doll-Pollard, Anne MD Doyle, Natalie MD Dsouza, Jessica NP Duff, Richard MD Duggirala, Subash MD Duncan, Deborah MD Duncan, Ulric MD Dunmore, Gwendolyn MD Duplantier, Noel MD Durelle, Scott MD Dyer, Bermesola DNP Earl, Lawrence MD Ebirim, Reginald MD Egbuchunam, Christie MD Elemuren, Iyabo MD Elkind, Barry MD Elsheikh, Ibrahim MD Epstein, Jack MD Everett, Linda MD Ezeigbo, Walter MD Fabrizio, Elisabeth NP Falcon, Leigh MD Famularcano, Lea MD Farhangfar, Kamyar MD Farhat, Laila MD Farmer, Stephen MD Farooque, Abdullah MD Fazil, Irfan MD Fazz, Hugo MD Feinberg, Herbert MD Feingold, Adam MD Fernandez, Luis Feuer, Randall MD Fignar, Timothy MD Filip, Leticia MD Finkelstein, Seth MD Fish, John NP Fix, Bryan NP Flores, Maria MD Francis, MSN, APRN, FNP-C, Lauren Frankel, Loren MD Franklin, William MD Frantz, Mildred MD Freeman, Stephanie MD Friedell, Peter MD Fruitman, Edward MD Fulton, William MD Gajraj, Jason MD Gao, Patricia MD Gardner, Catherine NP Gardner, Tabitha NP Garrison, Julianne MD Genova, Lisa NP George, Mary MD George, Melissa MD Ghaly, Antoine MD Ghoshal, Piya MD Giannakopoulos, Andre MD Gibbons, Olga MD Giles, Cynthia DO Gill, Nikita MD Gill, Reva MD Givens, Kimberly FNP Glover II, Richard MD Golden, Patrick MD Golshan, Hedyeh MD Gonzalez, Victor MD, FACS Goodwin, Philip MD Goolsby, Robert MD Gorich, George MD Gossman, Pamela NP Goykhman, Stanislav MD Graf, Jeffrey H. MD, FACC Gray, Jarid MD Gray, Leigh MD Green, Rhonda MD Greenfield, Debra MD Gribbin, Dorota MD Griffin, Christopher MD Grigsby, Holly MD Gruber, APRN, WHNP-BC, Carol Guido, Michael MD Guillaume, Alain NP Gujja, Rajitha MD Guzman, Octavio MD Gyarteng-Dakwa, Kwadwo MD Haddad, Sinan MD Hakli, Orhan NP Hale, Anne MD Hall, Eric MD Hallstrom, Laun MD Ham, Johnnie MD Hamby, Jeffrey MD Hana-Bachuri, Nada MD Haney, Jamey CRNP Harper, ARNP, MSN, Jennifer Harper, John DC Harris, Todd Harry, Eudene MD Hartley, Cindy MD Hartsuch, Tom MD Hartvickson, Robyn MD Hasso, Fawaz MD Hasso, Maha Hatch, Allan MD Heba, Mikhail MD Hefferan, James MD Hegde, Annapurna NP Hegwood, Teki MD Heiner, Andrew MD Heinrich, Kenneth MD Herbert, DO, APRN, MSN, Mary Higgins, George MD Hill, Nathan MD Hisel, Christopher MD Hitchcock, Jessica NP Ho, Larry MD Hochwald, Emily NP Hollenberg, Stephen MD Holton, Cindy NP Holtz, Andrew DO Homer, Stuart MD Homer, Stuart MD Hong, John MD Horvitz-Rist, Nancy MD Hostetler, Barbara MD Hott, Chad NP Hsieh, Jennifer MD Hubahib Florida, Hannah MD Huls FNP-C, Jennifer Hussain, Ruby MD Hutcheson, Olivia FNP Hyman, Martin Hyslop, A. Thomas MD Ibe, Eberechukwu MD Ibrahim, Rania DO Ijaola, Hope MD Inbody, Jeanie RNCNP Ingram, Jill DO Isaac, Jay MD Ishola, Nusirat NP Israel, Roza MD Jackson, Richard MD Jacob, Laith MD Jacobsen, Lynette MD Jaffer, Salima MD Jalomo, Patty NP Jani, Nika MD Janowski, Lawrence MD Jin, Chongfei MD Johnston, Kimberly MD Jones, Debra MD Jones, Kevin MD Jovanovic, Kevin MD Justin, Michael MD Kamepalli, Ravi MD Kanaan, Elias MD Kaplan, Michael DO Kassam, Mary Jane MD Kassam, Mohamed MD Kaydahzinne, Carol Kemp, Scott DO Khan, Kaleem MD Khan, Shujauddin MD Khan, Zafar MD Kheder, Abdul-Hady MD Kilpatrick, Nikara PA-C Kirson, Inbar MD Kiser, Benjamin Luke NP Kittrell, Laurel MD Knapp, Michael DO Ko, Christine MD Koby, Gregory DO Kohli, Rajpal MD Kokoszka, Joseph MD Kotewa, Holly FNP Kravitz, Joel DO Krieg, Karen DO Krummel, Jessica WHNP Krutzik, Ramona MD Kumar, Radha MD Kumar, Sumit MD Laauwe, Karen MD Labatia, Sherif MD Laffey, Elizabeth MD Lafleur, Naomie FNP Lagerkvist, Dawn MD Lahiri, Dev MD Landry, Charles DO Lashley, Glenna NP LaStrap, Rhodesia DO Latortue, Jean MD Lawrence, Shereda NP Leach, Lindon Lebow, Joan MD Lee, David W. MD Leipzig, Shari MD Leisy, Marylyn Ann MD Leon, David MD Leslie, Chasheryl MD Leslie-Brown, Heather MD Lester, Brandi CRNP Levin, Steven MD Lewis, Clementina MD Lewis, Henry Lewis-Traylor, Angela MD Liao, Katherine MD Ligham, Dwight MD Lockman, Brett DO Long, Donna FNP Lopez, Jose MD Lopez, Manuel MD Louis, Michelle DO Love, Joseph MD Luckay, Kenneth DO Lykes, Natalie NP Magnuson, Danielle NP Mahajan, Raj MD Mahan, Kristin FNP Mahmud, Mohammad MD Mahood, Karen DO Maida, Martin MD Malik, Nadia MD Malik, Rakesh MD Malireddy, Jyothirmayi MD Mangoba, Luther MD Manna, Sandra FNP Manoj, Smitha MD Mantha, Usha MD Mariyappa, Anu MD Marko, Bruce MD Marrero, Miguel A MD Marshall, Courtney PA-C Marshall, Deressa FNP Marshall, Elizabeth PA-C Martin, Kristin DO Martin, Laura FNP Martin, Stephanie NP Martinez, Lynore MD Mason-Morton, Kathleen PA-C Mathieu, Vladimir MD Matta, Ayman MD Mays, Danny PA Mazingo, ARNP, MSN, Abigail McBride, James MD McCarthy, Edward MD McClendon, David MD McCloud, Willie MD McDonald, Daniel MD McDonald, Joseph MD McEntyre, Clint MD McGettigan, John MD McGrath, Stephanie NP Meaux, Rachelle MD Medlock, Leia NP Mehta, Sudha MD Menchaca, Arturo MD Mendez, Megan NP Mercer, John MD Merrick, Helen FNP-BC Messamore, Debra Meyer Grimes, Leslie MD Meyering, Donald MD Meyers, Owen MD Miele, Danielle MS, PA-C Milek, John MD Miller, Amy MD Miller, Charles DO Miller, Dennis DO Miller, Elizabeth NP Miller, Elliot MD Milstein, David MD Minnis, Ramona MD Mischler, ARNP, MSN, Nicole Mitra, Shyamal MD Mooney, Stephen MD Moore, Patrick MD Moreno, Johnny MD Morgan, Jennifer NP Morgan, Stanley MD Morgan, Timothy MD Morse, Kimberly MD Moss, Douglas MD Munir, Muhammad MD Munsayac, Marissa DNP Murray, Rink MD Mustafa, Mahmoud MD Muzykoski, Mallory FNP Myers, Amy NP Myers, Craig MD Nahas, Osama MD Narang, Harcharan MD Narang, Yadvinder MD Narayan, Puneet MD Nawab, Zainab MD Nayak, Suresh MD Neef, Thomas MD Neff, Kevin MD Negron, Jose MD Nelson, Alan DO Nemechek, Patrick DO Ness, John MD Nestor, Gregory MD Ng, Anthony MD Nord, Bridget MD Nord, Daniel MD Nouri, Fouad MD Nuako, Kofi MD O'Brien, Maria MD O'Connor, Donald MD O'Dowd, Stacy MD O'Kelley, Kenneth MD O'Neal, Kevin MD Oczko, Agata MD Odi, Emmanuel MD Ofori-Awuah, Lorraine MD Okoroji, Chukwuma MD Okwara, Ikechi MD Olson, Lauren PA-C Ortega, Gezzer MD Ostermann, Kenneth MD Ostroff, Jonathan Osuagwu, Chuck MD OSUJI, IKECHUKWU MD Pabla, Rita MD Padhiar, Nirmala MD Pamganamamula, Madhu MD Pampin, Robert MD Paradela, Grace MD Parikh, Jeannine MD Partridge, Evelyn DO Passen, Martin MD Patel, Bhupendra MD Patel, Kalpeshkumar MD Patel, Kamal MD Patel, Seema MD Patel, Suryakant MD Peacock, Brandy NP Peffall, Vanessa NP Penn, Deane MD Perrault, Jillian NP Petch, Cammi PA-C Petrick D.C., Jon Pilli, Suja MD Pinedo, Nancy MD Pinto, Matthew DO Pittaluga, Juan MD Pittman, John MD Platinum, MD Pope, Leslie Anne DO Preston, Brandy FNP-BC Price, Jared DO Proctor, Jr, Charles MD, FACS Profenna, Leonardo MD Puckett, Lynn MD Pultar, William DO Puro, Edward MD Qureshi, Sharmin MD Raeesy, Amir MD Raghavan, Kalpana MD Raguthu, Manjula MD Rajah, Ratnasothy MD Rajasekhar, Lakkaraj MD Randhawa, Gina MD Rangi, Jaiwant MD Rasner, Todd MD Rasool, Abid MD Reddy, Prathima Reddy, Sudhakar MD Reguera, Tiffany FNP Rehman, Hafeez MD Reindorf, Priscilla NP Reinertson, Jodie MD Richard, Robert MD Riederman, Mark MD Riles, Roxene PhD, FNP Rimando, Joe MD Ristau, Kara FNP Rivera, Ramon MD Robbins, Michael DO Roberts, Tracie FNP-BC Robinson, Jennifer NP Rodan, Amy NP Rodeffer, Henry MD Rodriguez, Deborah MD Rodriguez, Veronica MD Roseberry, Beverly MD Rosenfeld-Grunseid, Sheri MD Ross, Carolyn DO Ross, Karlene MD Rozehzadeh, Rabin MD Rudolph, Dianne NP Ruffalo, Ann PA-C Russell, Candace NP Russell, Laura NP Sabbagh, Mouin MD Saberski, Lloyd MD Sabido, Michael Sack, Jonathan MD Saini, Rajeev MD Saks, William DO Saleemi, Anees MD Samadi, Ramin MD Samiruddin, Mohammed MD Sampson, Joanna FNP Sandhu, Rosy MD Sannoh, Yetunde MD Santiesteban, Joseph MD Saraf, Kiran MD Sarmiento, Cheryl MD Sasser , Shalunda APRN, PMHNP-BC Sattar, Soha MD Schaefer, Richard MD Schermerhorn, Thomas MD Schlossberg, Paula MD, FACP Schmid, Kimberly MD Schmidt, J. David MD Schmidt, Jennifer DO Schnitzer, Ed MD Schroer, Melissa MD Schurgin, Brian MD Scott, Albert MD Serna, Aime MD Shah, Kamalesh MD Shakir, Saad MD Shamim, Talha MD Shankar, Prithvi MD Shanks, Beth PA Sharp, Charles MD Shirazy, Pejman MD Sickel, Christopher NP Siedlecki, John MD Simmons, Idella Simon, Rebecca MD Singer, Maurice DO Singh, Arun DO Siomos, Effie MD Slechta, Stacy DO Sloan, Barry MD Sloan, Rick MD Smith, Alana PA-C Smith, David MD Smith, Leah MD Smith, Milton MD Smith, Richard MD Smith-Haxton, Serese MD Snead, Brandon MD, MS Solberg, Sara MD Soudah, Hani MD Spinnato, Richard MD Stafford, Jacqueline MD Stanley, Gerard Jr. MD Stergis, George MD Sterling, Leroy MD Stevens, Kenneth MD Stevens, Monique Stillson, Linford DO Stippich, Cindy CNM Stone, Timothy MD Stovall, Thomas MD Straker, Michael MD Stuckey, Troy DC Sugimoto, Danny MD Sukha, Sunita Sunio, Gilbert MD Syal, Rajender MD Syed, Tanveer Szalkowski, Maciej MD Tagdiri, Keven MD Tamon, Malvis DNP Tejeda, Carlos MD Thomas, Joseph Thomas, Rinta NP Thomas-Montilus, Sandhya MD Tillman, O.E. Jr. MD Tiwari, Anandita MD Tong, Beverly MD Torres-Garza, Juan MD Tremayne, Paula DO Tremblay, Geoffrey MD Trencher, Lisa MD Tsai, Yong Tsynman, Donald MD Turnbull, Roberto MD Turner, ARNP, MSN, Christine Turner, Robert MD Twahirwa, Marcel MD Tyler, Ca'Seem FNP Ufondu, Solibe MD Ukegbu, Ibidunni MD Umali, Maria Sandra MD Underwood, Bridget NP Urquhart, Joann MD Vali, Asha MD Valle, Pamela NP Varde, Anjali DO Vaughn, Anita MD Vaughters, Bauer MD Vedala, Mythili MD Venkatesh, Thirumalesh MD Veres, Zachary DO Verma, Dharmendra MD Verma, Sagar MD Vest, Shawn NP Victorian, ND, Terah Vignali, Sergio MD Vignaroli, Laura MD Vila, Maria DO Villarreal, J.A. MD Vinson, Stella CRNP Vitualla, Agustin MD Wade- Foster, Marilyn NP Wagner, Barbara Wandisan-Rosete, Florence MD Wasserman, Mark MD Waters, Gordon MD Watunya, Barbara DO Weber, Kim MD Weisenfeld, Shari MD Weizer, Ilene MD Welch, Katie MD Wells, Orlandis MD Welter, Ryan MD Wenrich, Steven DO Wheeler, Elenita MD White, Kara NP Whitehurst-Brown, Debora MD Williams, Lori MD Williams, Mironda MD Wilson, Charity MD Wilson, Elizabeth MD Wilson, Kimberly CRNP Wilson, Robert MD Winfrey, Keith MD Wingo, Tim MD Wolf III, Lloyd DO Wolf, Gregory MD Wolf, Kimberly MD Wolf, Melissa MD Woods, Malaika MD Wright, Scott MD Wright, William Jr. MD Wynn, Alancia MD Yap, Jennifer DO Yorio, David Yorio, David MD Young, DNP, MSN, FNP-C, Amy Zaffer, Syed MD Zargarian, Naira FNP Ziaie, Ahmad MD Zimmerman, Heidi MD

Original Weight*

Current Weight*

Zip Code*

Age*

Gender* Male Female

Upload'Before' photo*

Upload 'After' photo*

Weight Lost*

What motivated you to start losing weight?

Why did you choose to visit The Center for Medical Weight Loss (CMWL)?

How did you find out about CMWL?

What programs did you try, if any, before turning to CMWL?

Please describe your weight-loss journey.

How specifically did the CMWL program help you to lose weight?

What challenges did you have while losing weight and how did you overcome them?

What have been the best parts about losing weight? (For example, improved health, better fitness, improved relationships, more positive outlook.)

How do you plan to keep off the weight long term?

Is there anything else about your weight loss success or your CMWL experience that you’d like to share?

Favorite CMWL Product*

Top Tip to Stay Motivated*

What I Like Best About CMWL*

Any other weight loss success tips you’d like to share?

I hereby grant Be-Thin, Inc. d/b/a The Center for Medical Weight Loss (“CMWL”) an irrevocable, perpetual, unrestricted, exclusive, royalty-free right and license to use, reproduce, display, sell, publish, and reuse and republish my weight loss story (my “Success Story” or “Testimonial”), including my name, relevant biographical data, other information concerning my experience with CMWL, including my weight loss, and/or my likeness as attached in the enclosed photograph(s) and any and all Images (as defined below) of me either alone or that are accompanied by other material, now or at any time in the future, throughout the world, in any and all languages, in any manner it so chooses and in any medium now known or later developed. Such use may include, without limitation, use on websites owned or operated by CMWL and located on the World Wide Web, in electronic or printed newsletters, in printed materials, in advertisements in any medium now known or hereinafter discovered, in corporate brochures and in any other promotional material. I acknowledge and agree that my Success Story and any Images may be reproduced and published in whole or in part and may be adapted in any manner by CMWL. I hereby waive any right to view, inspect, or approve any use of my Success Story or any Image and any materials incorporating my Success Story or any Image, and I acknowledge and agree that I will not have an opportunity to review the finalized material. I consent to the use of any printed matter or text in conjunction with the use of any Image. “Images” include, but are not limited to, photographs, negatives, video and digital images of me (either provided to CMWL or taken or created in connection with the CMWL weight management program) and any derivative works created from any Image. I warrant and represent that all of the facts contained in my Success Story are true, that I am a bona fide user of CMWL’s programs or products, that my Success Story accurately reflect my opinions and experience with respect to CMWL and the weight loss programs offered by CMWL, and that the Images have not been altered. I have not used any other weight loss products or services other than those offered by CMWL in achieving the weight referenced in the Testimonial and, if applicable, since I achieved such weight. I acknowledge and agree that I have the exclusive right and authority to grant the license granted herein to use my Success Story and any Images. I acknowledge and agree that all materials of any kind supplied by me to CMWL, including without limitation, written materials and Images in any medium, will become the property of CMWL and will not be returnable. I acknowledge and agree that there are to be no fees, commissions, or royalties paid to me for the use of my Success Story or any Image by CMWL and that I am not due any compensation of any kind from CMWL. I acknowledge that CMWL is under no obligation to use my Success Story or any Image. In the event that CMWL elects to use my Success Story, in consideration of such use, I agree that I will not hold CMWL or any of its directors, employees, shareholders, affiliates, agents or weight loss program providers (the “Released Parties”) responsible for, and hereby release the Released Parties from, any loss or liability resulting from or related to the use of my name, my Success Story, and/or any Image. I acknowledge that CMWL cannot prevent unauthorized third parties from downloading, copying and/or distributing my name, my Success Story and/or any Image from the internet. If any provisions of this authorization form are invalid, the remaining provisions continue in full force and effect. The laws of the State of New York govern this document. I warrant to CMWL that I am at least 21 years of age and have the right and authority to make this Release. I agree to notify CMWL in the event that I am no longer using CMWL’s products or services.

I agree to the Terms of Service