• Healthy Buoys Wellness Survey

    We look forward to exploring your health goals with you and, more importantly, guiding you on your path to optimal health!
  • Format: (000) 000-0000.
  • Are you currently taking medications for any of the following conditions?
  • Do you have any of the following?
  • Do you have any dietary restrictions or allergies? (Select all that apply)
  • Have you used in the past or are you currently using one of the following medically supported weight loss tools?
  • In regards to highly addictive foods, such as sugars/carbs, fried foods, and processed foods, how would you describe yourself?

  • We will cc the email address you've provided so you will receive a copy of the email sent to Michael & Dennis

  • Personal Information

  • CONGRATULATIONS for being at a Healthy Weight. Our program can help you with weight loss (if needed), long-term weight control, and new healthy habits to help you reach your Optimal Health and stay there!

  • Overweight - You're at increased risk of developing cardiovascular disease, heart disease, diabetes, and MORE without intervention. Our program can be lifesaving in helping you with weight loss, weight control, and new healthy habits to help you reach your Optimal Health for the long term.

  • Obese - You're at high risk of developing cardiovascular disease, heart disease, diabetes, and MORE without intervention. Our program can be lifesaving in helping you with weight loss, weight control, and new healthy habits to help you reach your Optimal Health for the long term.

  • You're at the highest risk of developing cardiovascular disease, heart disease, diabetes, and MORE without intervention. Our program can be lifesaving in helping you with weight loss, weight control, and new healthy habits to help you reach your Optimal Health for the long term.

  • Healthy Sleep

  • How many hours of sleep do you get in a typical night?

  • Healthy Motion

  • Healthy Mind

  • Food and Hydration Habits

  • How many ounces of water do you drink per day?
  • How many times do you eat out per week (including fast food)?

  • Healthy Finances

  • Are you interested in creating lasting success through personal growth and helping others improve their health, all while earning a great income?

  • Thank you for sharing your health goals with us. Once you hit submit, you will be directed to the online scheduling calendar of your friend/coach so you can book a time slot about next steps

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