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Break Free From Sugar

Before It Breaks You

Full Name *

Email *

Phone *

By checking this box, I consent to receive text messages related to my account, orders, or services I have requested. Reply STOP to opt-out.

What’s the single biggest challenge you’re facing with sugar, cravings, or energy right now? *

In the next 90 days, which outcome matters most to you? (Choose one) *

Break nightly snacking / “sweet tooth” cycles

Lose 10–30 lbs and keep it off

Stabilize blood sugar / avoid meds

Consistent daytime energy (no afternoon crash)

Better sleep / mood balance

If you decided to get help, which kind of support would you be most interested in? (Check all that apply) *

Kickstart 1:1 session to build a personal Sugar-Reset plan (then apply fee if I continue)

Small-group coaching for coaching + accountability

7-week group program with step-by-step guidance

Self-paced course with videos, checklists, and meal ideas

Weekly accountability circle (peer support)

Cookbook/meal plans (simple, real-food recipes)

Lab testing referral/coordination (if applicable)

Other

Which services would you invest in if you needed help? *

Age Range *

25–34
35–44
45–54
55–64
65+
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Life stage *

Busy professional
Parent with kids at home
Caregiver
Retired
Other
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Primary trigger you relate to most: *

Pre-diabetes
Diabetes concerns
Weight creeping up
Low energy or crashes
Evening or emotional eating
Poor sleep
Other
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In a typical year, how much do you invest in improving your health? *

$0
<$100
$100–$499
$500–$999
$1,000+
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How urgent is making this change right now? *

Not urgent
Must change now
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