Be curious!
That’s how we learn and grow as humans and I am happy to be the path that shines the light for your personal growth. No more excuses talking yourself out of opportunities and preventing you from becoming the person you always wanted and deserve to be. I believe in you!
Today's Date
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Month
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Day
Year
Date
Name
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First Name
Last Name
Phone Number
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Please enter a valid phone number.
Email
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example@example.com
Right now, how much do you weigh? (If you were like me, and afraid to step on a scale, how much do you think you weigh?)
Right now, how would you describe your overall health? Physical, mental, energy, self confidence….
Why do you want to lose weight? What do you think will be different in your life when you get to a healthy weight?
What would your dream health and weight goals look like?
What would you change in your life right now to make it better? Think about it. It is ok to share deep responses here. This is totally confidential. Share your story.
Are you being treated for any of the following?
Gout
Type 1 Diabetes
Type 2 Diabetes
Thyroid Disease
High Blood Pressue
High Cholesterol
Heart Complications
Other
Are you:
Pregnant
Nursing
Pre Menopause
Post Menopause
Rate the quality of your sleep.
How many meals do you eat per day?
Do you exercise?
How many pounds away are you from feeling confident?
How many other programs have you tried? Personally, I’ve tried so many.
On a scale of 1-10, how committed are you to getting to your health goals?
Additional comments you want me to know:
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