Optavia Wellness Form

Optavia Wellness Form
How are you...REALLY?

Are you ready to transform mentally, emotionally, and physically? The heartbeat of Optavia is to take care of the whole person: Mind, Body, and Finances. This program has changed my life not only in the way I approach food, but myself and my relationships. As a certified Optavia coach, the work we will do together is 100% honest and transparent. We will find the wound or wounds in your life that are holding you back from reaching your full potential. We will find out the WHY. We dig so deep that you will be able to come out on the other side even stronger than before. I will guide you, motivate you, listen to you, and be right by your side along this amazing journey. Be detailed and as honest as possible as you fill out this form. YOU CAN DO THIS! THIS IS THE FIRST STEP TO FREEDOM! Let me know if you prefer an email or text message to set up a 15 minute chat to talk about your goals.
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
What will be your deciding factor to get heathly?
When do you want to get started?

MonthDayYear
Date
How many times have you started a program and "failed" or gained the weight back?
Starting weight
Goal weight
Height
Please describe your current exercise routine (be honest). Please list any current health conditions, medications, allergies, etc
On a scale from 1-10, how ready are you to start this simple program and see improvements? Elaborate if necessary.
This program has 4 components: Coach, Community, Education, and Nurtrition. You will utilize all 4 components equally. Each one is just as important as the other for reaching your health goals and maintaining your results long term.

You will understand how your body and brain can function optimally. Are you ready to commit to yourself?
I would like to talk with someone regularly for accountability!I will contact you occasionally if I have a question.I would enjoy interacting via text messages and this is enough for me.I am open
I've been in a good fat burn before and I understand the concept.I've been eating poorly for a while and I'm not sure I can get back on track alone. HELP!I keep trying, but I have a hard time finding the willpower to stay on plan long enough to see any results.I think I'm doing everything right, but I'm frustrated with my results and don't feel like I'm losing at the rate I should be alone. I'd like to troubleshoot with you.I've hit my goal and am struggling figuring out how to maintain my results.
The minute you choose to move forward with Optavia, you are a health influencer to all those around you. Many of my health influencer clients choose to become a health coach. Would you like to hear the benefits like Accountability, Incredible income, Phenomenal Community, and Deeper Personal Growth? It is truly the most rewarding thing I have done and you will get to love and service others well. You choose how much time to invest in your growth; part-time or full-time. You earn enough to cover the cost of your fuelings or you could earn a full time income! It's completly up to you. You are the CEO.

I would be interested in exploring the idea of becoming a health coach and excited to deepen my own journey. Please send me more information.
Additional comments you want me to know
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Optavia Wellness Form

How are you...REALLY?