Decide/Commit/Succeed Re-Engaging Client Starting Point

Re-Engaging Client Starting Point

You are either my client or the client of a coach in my organization and we are so happy to have you back! If the later applies, I will forward this to your coach when I receive it from you. SOOOO GLAD YOU ARE BACK!!!
Right now, how would you describe your overall health? Physical, mental, energy, self confidence...*
Are you on any medications that might affect weight loss? (Include GLP-1 shots like Ozempic)*
Current Weight vs Goal weight*
Where are you in your health journey? *
Who is or was your coach? What could he/she have done better or differently to support you on your journey? Do you wish to stay with this coach?*
Why did you stop plan the first time? Or the 3rd time? What made you choose to quit? I want to know this information so we can help you more effectively this time. It took me a full year and half to DECIDE to go all in. You are not alone.*
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..."big boned" is a lie we tell ourselves)*
Do you Exercise? If so, what do you do? How frequently?*
What would your dream health/weight goals look like?*
What would you change about your life to make it better? I was sad, depressed, angry, and 220 pounds....so I ate, and ate, and ate. I get some deep responses here and this is totally confidential. Share away.*
On a scale of 1-10, how committed are you to changing your health?*
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
E-mail*
example@example.com
Thank you for taking the time to complete this form. YOU CAN DO THIS!!!

Nicole Mott - changeitallwithnicole@gmail.com - Instagram: @nicolemottstyle - FB: www.facebook.com/nicole.d.mott
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