HEALTH COACH EXPLORE

Your Healthy Starting Point!

Let's Build Healthy Habits Together! Are you ready to achieve your weight loss goals and improve your relationship with food? Together we will do more than count calories or macros. We will develop and work through a plan to help you transform your life into the healthy lifestyle you always wanted. As you fill out this form be detailed, honest and brave. A few weeks with me and this will all CHANGE! Let's get started!
Full Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
How old are you?
What is your occupation?
Right now, I know this might be hard but tell me how much you weigh and your height? If you haven't gotten on a scale in a while, how much do you think you weigh?*
Right now, how would you describe your overall health? Physical, mental, energy and self confidence?
Why do you want to lose weight? What will be different in your life when you get to your healthy weight?*
Any medicine? Thyroid, Anxiety, Depression or Off Label Diabetic Injections?*
Are you being treated for any of the following?

GoutType 1 DiabetesType 2 DiabetesThyroid DiseaseHigh Blood PressureHigh CholesterolHeart ComplicationsOther
Are you....

PregnantNursingPre-MenopauseMenopausePost Menopause
What are your dream health/weight goals?
Rate your quality of sleep?
How many meals do you currently eat per day?
Do you exercise?
How many pounds are you away from feeling confident?
How many other weight loss programs have you tried in the past? ( I have tried 20 before I found this amazing plan!)
On a scale of 1-10, how committed are you to getting to your health goals?
I am 100% confident in this program and it's ability to work for anyone. There are 4 COMPONENTS and all 4 are equally important for reaching your desired weight and health goals. This is more than a diet, it is a way of living that will help you maintain your weight loss for the long term.

Coaching

Community

Education

Nutrition
Are you ready to commit yourself fully to all 4 components?

AbsolutelyNot sure
Is there anything else I should know to support you in your health journey?
Congrats! You made the first step toward your NEW LIFE. I know this might have been difficult but I am here to help you accomplish your health goals. I will be in touch soon so we can talk about the best program for you!
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Your Healthy Starting Point!