Just wait..in a few weeks, yes a few weeks, with working with me this will all change!
Name
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First Name
Last Name
Email
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example@example.com
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
When is your birthday?
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Month
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Day
Year
Date
How did we get connected? If you were referred, please write their name below
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What is your current weight and height? If your unsure of the exact number you weight, what do you think it is?
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How would you describe your current health overall? Physical, mental, energy, self confidence?
Why do you want to lose weight? What do you think will be different in your life when you get to a healthy weight? (and yes you can, you are not too old, too big boned or doomed).
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What would your dream health/weight goals look like?
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What would you change about your life right now to make it better? (this is fully confidential, please be honest with yourself.. and me)
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Any medications? Thyroid, blood pressure, anxiety, depression, diabetes, glp-1 ? Any allergies?
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Are you being treated for any of the following:
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Gout
Type 1 Diabetes
Type 2 Diabetes
Thyroid Disease
High Blood Pressure
High Cholesterol
Heart Complications
None of the above
Other
Are you:
Pregnant
Nursing
Pre Menopausal
Post Menopausal
Rate the quality of your sleep
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How many meals do you eat per day?
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Do you exercise? If yes, what?
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How many pounds are you away from feeling confident?
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How many other weight loss programs have you tried? I tried a lot before finding one that worked!
On a scale from 1-10, how committed are you to reaching your health goals?
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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!
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