It’s Time for a Metabolic Reset

It’s Time for a Metabolic Reset

We are Healthy Edge 3.0! We are certified metabolic health and lifestyle coaches. These questions help your coach understand what brings you here and how this program will be a strong fit for you.
Research shows that there are 6 significant factors that contribute to your overall health. To determine if one of our programs could be right for you, please complete this form.
Tell Us About You
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Your Time Zone / State
How did we meet? Person who shared this form with you?
If you work, what kind of work is it that you do?
On a scale of 1 to 10, how much do you enjoy what you do?

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1 is I hate it, 10 is Very happy
Current Health Snapshot
Age
Height?
Current Weight
Goal Weight
Do any of these apply to you? (select all that apply)

Other
Please list any and all medications or supplements you are taking, and what you may be specifically taking them for:
Do you have any food allergies, restrictions, or aversions?
Are you pregnant or nursing?
Have you tried to lose weight before? If yes, what have you found to be the most difficult part of losing weight in the past?
Are you currently on any diet or health program? If so, please explain.
Sleep and Energy
On average, how many hours of sleep do you get each night?
How would you rate the quality of your sleep on a scale of 1 to 10?

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1 is Horrible, 10 is Excellent
How would you rate your daily energy level?

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1 is Poor / Lowest, 10 is Thriving / Highest
Hydration
How much PLAIN water do you drink in a day?
Do you drink coffee? If so how much coffee do you drink in a day, and how do you take it?
How much alcohol/soda/sweet tea weekly or monthly do you consume? What are your drinks of choice?
Movement
Do you currently exercise? Describe the type and intensity of the healthy motion you typically do. (If you don’t currently move your body, that’s OK! If you are currently incorporating healthy motion into your week, please share how many times per week.)
Are there physical things you would like to do that you are currently unable to?
Stress
On a scale of 1 to 10, how would you rate your overall emotional wellbeing right now?

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1 is Thriving, 10 is SOS/ High Stress
Describe your most common sources of worry or stress. How do they affect your daily life?
Eating Habits
What does a typical day of eating and drinking look like for you? (This includes anything that goes into your mouth - coffee, alcohol, snacks, etc.)
When do you eat your first meal of the day?
How many meals per day do you eat?
How many snacks per day do you eat?
When do you eat your last meal or snack?
On average, how much do you spend on snacks, meals, and drinks each day?
How many days a week do you eat out or grab food/drinks on the go? (Coffee runs, fast food, sit down restaurants, take out, vending machines, etc.)
What are your favorite foods or meals? (i.e. What do you have for breakfast, lunch or dinner. Mexican, pizza, vegetarian, chicken, beef, fish, salad, etc.)
Your Vision + Your Why
It’s important for us to hear what you would like to accomplish in your health. Please select all that apply.

Other
What is your main motivation for wanting to make changes to your health? (Relationships, activities, how you will feel, confidence, etc.)
Your Current Metabolic Symptoms
Which of these describe you right now?

Other
Are You Ready for a True Metabolic Reset?
If there was a proven path that burns fat, protects 98%-100% of your lean muscle, and reverses metabolic dysfunction, how open are you to following it exactly as designed?
Are you prepared to invest time, energy, and money into your health if the plan fits you?
How soon would you want to start?
COMMITMENT LEVEL: On a scale of 1-10 how committed are you to making lasting changes in your health?

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1 is Not so sure, 10 is Let’s do this!
Is there anyone else in your life who would like to get healthy with you? It is fun and inspiring to do this with a friend or family member, and surround yourself with a healthy community!
Anything else you want me to know?
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This program has transformed thousands of lives (including mine!) through science-backed methods and proven results.

The formula is simple: when you commit to the process, results follow.

Here's the beautiful truth: YOU are the author of your success story. While I'll be here guiding you every step of the way, your commitment lights the path.

Yes, change can feel challenging - those old habits didn't form overnight! But imagine the joy of finally taking control of your health, feeling energized in your daily life, and showing up as your best self for those you love.

In 2019, I stood exactly where you are now. Uncertain but hopeful. Ready for change but nervous about the journey. Today, I can tell you it was the best decision I ever made - not just for me, but for my whole family.

Your time is now. Your transformation is possible. And your future self will thank you for this moment.
Should be Empty:

It’s Time for a Metabolic Reset

Tell Us About You

Current Health Snapshot

Sleep and Energy

Hydration

Movement

Stress

Eating Habits

Your Vision + Your Why

Your Current Metabolic Symptoms

Are You Ready for a True Metabolic Reset?