Fields Health and Wellness Introduction

Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Healthy protein optionsProtecting muscle healthWeight lossGiving my children healthy food choicesCoaching business opportunityOther
YouFriend or Family MemberSocial MediaOptavia AdOther
Who referred you?
1. If you knew you couldn’t fail, what would you want to change about your current health? Ex: lose weight, gain weight, improve general health, learn proper nutrition. Please provide as many details as you can (How much weight, physical goals, etc)*
2. What is your greatest stuggle when you try to reach those goals on your own?*
3. How will you feel when you reach those goals, what will you potentially be able to do or accomplish that you can't now?*
4. Are you also considering medically supported weight loss methods (ie bariatric surgery or GLP-1 shots)? If yes, provide details.
DiabetesHigh blood pressureCholesterolThyroid issuesGoutKidney diseaseLiver disease (not including fatty liver)Fatty Liver DiseaseOther
6. List any allergies
7. Is there anyone else in your life whom you would like to join you on this journey to better health? If yes, who would you invite?
8. I coach people in three areas of health — healthy body, healthy mind and healthy finances**. Please rank those in order of importance for you.
**OPTAVIA makes no guarantee of financial success. Success with OPTAVIA results from successful sales efforts, which require hard work, diligence, skill, persistence, competence, and leadership. Please see the OPTAVIA Income Disclosure Statement (https://optavia.me/IDS) for statistics on actual earnings of Coaches.
I began my health journey in January 2018 after I had developed a lot of unhealthy habits which led to a lot of weight gain. With heart disease rampant in my family, I feared that I would have a heart attack or face open heart surgery at an early age. I lost 60 pounds in just over 6 months on one of our weight loss programs*. No diet pills or extreme exercise. Just one on one personalize coaching, a supportive community, education, and solid nutrition. I personally have been able to sustain a healthy weight by continuing in the healthy habits I learned, and by leaning on the elements of our program which helped me be successful in weight loss also.

The good news is that I believe our program is for YOU too and that you will be just as successful in your health as I have been. I'd be honored to walk this journey with you just as my coach did with me.

*Average weight loss on Optimal 5&1 Plan is 12 pounds. Clients are in weight loss, on average, for 12 weeks.
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