Yes, tell me how TOPS can help my patients/clients...
RequiredRequired Question(s)
Required 1.
Please send me:
(Select all that apply.)

Samples of free TOPS healthcare resources for patients/clients
Info on starting a TOPS weight-loss support group for employees or patients/clients
TOPS twice monthly weight-loss and wellness email newsletter
A copy of TOPS' 304-page book, "Real Life: The Hands-on Pounds-off Guide"
I would like someone to contact me.
Required 2.
TOPS provides materials specifically for use by healthcare and social services professionals in their practice.

What are your professional credentials (or title if no degree)? (MD, RN, MSW, LPN, administrator, case worker, etc.)
 

50 characters left.
Required 3.
What is your specialty? 
(Select all that apply.)

Administration
Alternative Medicine
Bariatrics
Cardiology
Chiropractic
Community/Faith-based (YMCA, rec. or senior center, church, etc)
Diabetes Education
Family/Primary care
Gastroenterology
Geriatrics
Internal Medicine
Nutrition Counseling
Obstetrics/Gynecology
Orthopedics
Pediatrics
Physical Fitness
Podiatry
Preventative Medicine
Psychiatry
Social Services/Governmental
4.
Thank you for requesting more information.

TOPS will never sell or share your contact information, which we use solely to provide materials and support you request.

Please provide your name and email, along with any other contact information you feel comfortable sharing.  Remember, we'll need your mailing address if you requested samples.

By entering my personal information, I consent to receive email communications from the survey author's organization based on the information collected.

First Name:
Last Name:
Company Name:
Work Phone:
Email Address:
emailaddress@xyz.com
Address 1:
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City:
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(US/Canada):
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