Get Started Now With
The Laux Weight Loss Program

Sometimes all of this technology can make everything feel a little impersonal. We want you to know that we are real people behind this website and we care about your struggles, progress, and triumphs.

Complete the registration form below and our office staff will contact you to discuss appointment availability and your payment options.

Welcome to "Your Last Diet"!

Please enter a comment below about what you want to accomplish with regard to weight loss.
Please Check Any That Apply to You*
I want to lose weight
I would like to maintain my weight
I want to increase my confidence
I have specific weight related health concerns I would like to resolve
I would like to complete the program with my friend/spouse (please enter their name below)
Friend or Spouse's Name
How many pounds would you like to lose?*
Exercise is recommended, but it's optional*
I don't exercise regularly or prefer not to
I workout regularly but would accept advice/recommendations
I would be interested in: starting a formal exercise program or a separate gym membership
First Name*
Last Name*
E-mail Address*
Street Address*
Zip/Postal Code*
Home Phone*
Cell Phone
Is It Okay to Contact You Via TXT Messages?
How Did You Hear About Laux Chiropractic and Weight Loss Clinic? If Someone referred you, please let us know whom to thank!*
Internet Search
Dr. Laux's Newsletter or Mailing
Newspaper Ad
Radio Ad
Friend (please list below)
Other (please list below)
Please Enter Any Comments You Would Like to Add

Please enter the word that you see below.


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