Your Health Starting Point w/ Coach Jessica
First, I want to tell you that you are gorgeous and worthy! Size is not what makes that true. Getting healthy is the true goal! Weight loss is simply a side effect of learning new habits for long-term health. You will be amazed at what’s possible in just days and weeks. My program is clinically proven to REVERSE METABOLIC DYSFUNCTION!
Are you struggling with any of these signs of metabolic dysfunction?
Intense cravings (sugar or carbs)
Stubborn belly fat
Feeling hungry after eating
Afternoon energy crashes
Chronic fatigue (even after full night’s sleep)
Frequent inflammation or bloating
Brain fog or trouble concentrating
Disrupted or poor-quality sleep
Low mood or irritability
Feeling puffy or inflamed
Elevated fasting glucose
High triglycerides
Low HDL
Insulin resistance markers
Skin issues (acne, dark patches, skin tags)
Irregular cycles or worsening PMS
Difficulty building muscle
Slow recovery after workouts
How much do you weigh? If you are avoiding the scale, how much do you think you weigh?
*
How many pounds are you away from feeling confident?
*
If you’re confident at any size, how many pounds are you away from your initial weight loss goal? ;)
What would your dream health/weight goals look like?
Right now, how would you describe your overall health? Physical, mental, energy, self confidence…
*
What do your dream health/weight goals look like? Why do you want to lose weight? What do you think will be different in your life when you get to a healthy weight (which you can!)
*
What would you change about your life right now to make it better? I get some deep responses here and I want you to know this is totally confidential. Share away...
Women…Are you:
Pregnant
Nursing
Perimenopause
In Menopause
Postmenopause
Are you being or have you ever been treated for or diagnosed with any of the following?
Gout
Type 1 Diabetes
Type 2 Diabetes
Prediabetes
Thyroid Disease
High Blood Pressure
High Cholesterol
Fatty Liver
Heart Complications
Kidney Complications
Gallbladder Complications
PCOS
Insulin Resistance
Autoimmune (explain below)
Other (explain below)
Do you have any other medical history you think would be relevant to your health journey?
If you marked “Other” above, please explain here.
Do you have any food allergies or dietary restrictions?
Describe the quality of your sleep?
*
How many times do you currently eat per day?
*
Include snacks and desserts.
How much do you spend on groceries & eating out & Starbucks runs etc PER WEEK? Approximately the portion that’s for YOU ONLY.
*
(For example, if you have a family of four, divide your weekly food budget by 4…vary this based on the ages of your kids and how much they consume ;)
Do you exercise?
Briefly describe frequency and intensity.
How many weight loss options have you tried? It’s normal to try several or many and think nothing else will work (it will!)
*
I’ve never tried to lose weight before
1-3
4-6
6-10
I’ve tried everything
Are you currently taking or considering taking GLP-1 weight loss injections? It’s important to have a nutrition strategy if you are taking injections.
Currently taking
Considering taking
Used to take
Not applicable
On a scale of 1-5 (with 5 being ready today), how committed are you to getting to your health goals?
*
Just Curious
1
2
3
4
I’m Committed!
5
1 is Just Curious, 5 is I’m Committed!
I am totally confident in the program I coach and its ability to work. Literally, you are the only variable to the program’s success. It’s 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 coaching. With you being the only variable: if you fail or if you succeed, it’s your choice. 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 about having control over something that will help you get healthy?
What is your full name?
*
First Name
Last Name
What is your mobile phone number?
*
Please enter a valid phone number.
What is your email?
*
example@example.com
How did you hear about my coaching?
*
Include group name or referral name
I can’t wait to connect with you!
Thank you for being vulnerable here and letting me into your corner so I can cheer you on! I’ll be in touch.
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