Optavia Health Form

Becky’s Health Starting Point

Just wait... a few weeks with me, yes, just weeks and this will all change…..
Name

First NameLast Name
Contact Number
Best day/time to contact you?

DayTime
Where did you hear about me?

Other
Do you have a coach?
Let's talk about your goals!
I want to improve in the following areas:

Other
What is your why? (Is there an event you are working towards? Fit into your clothes better? Want to clean up your lifestyle?) Be specific!
Right now, how much do you weigh and how tall are you? If you were like me and didnt get on the scale, how much do you think you weigh?
Medical Conditions/Allergies
Do you have any medical conditions or allergies?
If yes, please specify:
Are you currently working out?
Are you currently pregnant or breastfeeding ?
Dietary Analysis:

Please complete these question in order for me to provide a proper dietary analysis. Based on the information provided I will be able to match a personalized plan designed just for you.

Do you..............

I am 100% confident in the program and its ability to work for everyone. Literally, you are the only variable to the programs success. Its simple, not always easy, but the things that matter in life are never easy. I know you can lose the weight you want with my help, but with you being the only variable, if you fail, its your fault, if you succeed its also your fault. How does that make you feel? Scared? Good! I was too. BUT, my life was in shambles because of all the things I could NOT control. I decided to be excited that I could control one part of my life. How do you feel now? I am so excited to work with you!
Thank you so much.

Looking forward to speaking with you!!

CLICK THE LINK BELOW TO SUBMIT & I WILL BE IN TOUCH WITHIN 24 HRS
Should be Empty:

Becky’s Health Starting Point