Health Starting Point
Choosing yourself will change your life in just a few weeks... Together we can create the change you dream of
Tell me your full name 😃
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Tell me how you heard about this program? (Please include first & last name if you were referred)
Right now, how much do you weigh? If you do not get on the scale, how much do you think you weigh?
How would you describe your overall health today? Physical, mental, energy, self confidence…
Why do you want to lose weight? When you get to a healthy weight, what do you think will be different in your life? (You can live a busy life with kids, travel, work etc. and get to a healthy weight. It is possible!!!)
Tell me about what your dream health & weight look like?
If you could change your life right now, what would you change to make it better? I get some deep responses here, This is totally confidential so please share.
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 = no sleep; 10 = sleeping the entire night
How many meals do you currently eat a day?
Do you exercise?
What is the number of pounds you need to remove to feel confident?
How many other weight loss programs have you tried? I've tried several programs and failed at every single one. I was so FRUSTRATED with myself that I could not keep the weight off. I can help...
How committed are you to reaching your health goals?
1 = Not ready; 10 = Ready for changes
I am 100% confident in this program and its ability to work for everyone. You are the only variable to the program’s success. This program is simple, but not always easy. Things in life are never easy...right? I know you can lose the weight you want to with my help. You are in control of your results. If you have excuses and/or fail, it‘s your responsibility just like if you SUCCEED – YOU are in control of the results you get! How does that make you feel? Scared? Good! I was so scared to start another program especially with some of the health issues I had. I was at the lowest point of my life – depressed, the heaviest I had ever been, and dealing with health issues (most of which I created on my own). NOW, I control my health and feel like the new person I was dreaming of for years. How do you feel now? I’m very excited to work with you!
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