Tell me a little about you.
It will only take 2 minutes!
Name:
First Name
Last Name
Email:
example@example.com
Phone:
Please enter a valid phone number.
Right now, how would you describe your overall health? Physical health, mental health, energy, self confidence:
Why do you want to lose weight / get healthy? How will your life improve?
Are you being treated for any of the following?
Gout
Type 1 Diabetes
Type 2 Diabetes
Thyroid Disease
High Blood Pressure
High Cholesterol
Heart Complications
Other
Are you.....
Pregnant
Nursing
Pre Menopause
Post Menopause
Rate the quality of your sleep: (1-terrible; 10-amazing)
How many meals do you currently eat per day?
Do you exercise? If so, how frequently and what type of exercise?
When were you last happy with your health? Tell me about that.
On a scale of 1-10, how committed are you to getting to your health goals?
I am 100% confident in the program I coach. You are the only variable to the program's success. This program is simple - not always easy - but the things that matter in life are never easy, right?! I know you can do this and will coach you every step of the way. If you're anxious or scared, that's ok! I was when I first started, too. BUT, I was READY. Are you ready? Is there anything else that you'd like to share with me?
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