Getting Healthy with theDBinfluence

Getting Healthy with theDBinfluence

Hello and welcome! My name is Danielle Gantt, and I want to personally thank you for taking the time to fill out my health survey. This will allow me to tailor a program to meet your goals! 5 1/2 years ago I was in your shoes and nervous about starting something else that I figured I was 'probably going to fail at' :( Ugh! I was a (crabby) single mom of 3, in a failing relationship, struggling with my health, tired, and lacking confidence or direction in life. I was so tired of my own excuses and felt like garbage 80% of the time! I knew I needed to lean into this program, trust the process (and my coach) and fully commit to my health once and for all! Almost 6 years later I'm more confident than before, sleeping so much better, happier in general and feel like I'm thriving in my 40's! In the past 5 years I have helped over 14,000 people discover health and wellness and it would be my pleasure to help you, too!
Name

First NameLast Name
E-mail
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Date*

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Date
Age
These next few boxes are for you to share anything with me that might be beneficial for me know so I can HELP YOU BEST! Anything you share is confidential.
How did you hear about me, or our programs? Have you done Optavia in the past? If so, who was your coach.
What would you like to accomplish most with your health and wellness (lose weight, sleep better, less stress, come off medications, more energy, etc)?
Please describe your main motivation for making changes to your health. Studies show that the people who have a STRONG WHY are 80% more likely to be successful than those who have a wishy-washy WHY. Other people have said: "Improve relationships my my life", "to be apart of activities again", "feel better mentally", "so my family doesn't have to take care of me", "to be around for my kids/grandkids", "have intimacy with my husband again", "get out of debt", "have more confidence"...etc.
BMI
Based on your height and weight right now, what is your current BMI number (the chart is below for you to look at).
What is the BMI value you'd like to be at when you are at your goal weight?
Medical

If you are currently taking any medications for diabetes, thyroid, metabolic issues, blood pressure, blood thinnter, or had weight-loss surgery or are using weight loss medication such as: Ozempic (semaglutide), Wegovy, Tranot, etc this is A-OK, and I CAN HELP YOU, too!! I have many clients that have been very successful and able to maintain their weight loss in a healthy fashion with quality nutrition and lifestyle/habit changes. This is not just a quick fix diet. In fact, we don't use that nasty word here (DIET)...this is about LIFESTYLE, and my goal is to help you have a life you want to wake up for, and participate in, EVERY DAMN DAY with confidence and gratitude!
Sleep
How many hours of sleep do you typically get?
What time do you typically wake up and go to bed?
How is your quality of sleep and do you wake up feeling rested?
Hydration
How much water do you drink each day?
Do you consume any other beverages?

CoffeeSodaTeaAlcoholJuice (Apple, Orange, Fruit, etc)Energy Drinks
Motion
How would you rate your daily energy level on a scale of 1 (lowest) to 10 (highest)?
Do you currently exercise? If so, how many times a week? We have specific programs for people who are active and other ones for people who do not have time to workout right now.
What physical / exercise activities do you participate in?
How would you describe your daily activity level?
Stress
How would you rate your daily stress level on a scale of 1 (little stress)-10 (high stress)?
What do you do for work?
Are there any other stressors in your life that might be standing in the way of you feeling your best?
Eating Habits
How many meals per day do you eat?
Do you snack in between meals? If so, what snacks?
How many days a week do you eat out or grab food on the go? (coffee runs, fast food, sit down restaurants, take out, vending machines, etc)
Weight
Current Weight: (if you want to share)
In a perfect world, if you could not fail, how many pounds would you want to lose?
Height:
What has been the most difficult thing about losing weight in the past?
Is there anyone in your life who would like to get healthy with you? I have seen great success for those folks who join with a friend or partner. I also offer a discount if you sign up with a friend! ;)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
On a scale of 1 to 10, how ready are you to make changes to improve your health?

1

2

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10

1 is Just thinking about it, 10 is Ready for change!!!
If you would like to schedule a follow-up call to further discuss your health goals and what programs might work best for you, please feel free to use this link to schedule a time for a short, NO PRESSURE, phone call! This call is to help answer your questions, add you to a fun group where I post recipes, tips and tricks and motivational stuff (if you want)! I really mean it when I say...I have a passion for helping my clients feel as good as I have felt the past 5+ years! Not just physically, but mentally and finacially, too! I want to throw you the life raft, get you in the boat and show you the way to dry land where you are able to stand on your own two feet, with confidence and pride!!

Click this link to set up a time to chat and get your questions answered
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Getting Healthy with theDBinfluence

BMI

Medical

Sleep

Hydration

Motion

Stress

Eating Habits

Weight