Metabolic Reset Pathway
We are so excited you're interested in taking your health to the next level! Please fill out the survey below and we will be in touch with you on the next steps to better health. -Jeff + Erin Bahrenfuss
Tell Me About You!
Name
*
First Name
Last Name
Email
*
example@example.com
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How did you hear about me?
*
Preferred Method of Contact
*
Text
Call
Have you previously been on Optavia?
If so, when and what happened?
If so, who was your coach?
Where You Are Now
Describe why you are interested in getting healthy.
When was the last time you remember feeling your best in your health or being at your ideal weight or size (if that's part of your goal)?
Your Current Metabolic Symptoms
Which of these describe you right now?
Fatigue or low energy
Difficulty losing weight
Poor digestion or bloating
Mood swings or irritability
Sleep problems
Sugar cravings
Brain fog or difficulty concentrating
Slow metabolism
Hormonal imbalances
Frequent hunger or overeating
Other
On a scale of 1-10, how out of sync does your metabolism feel?
Thriving
1
2
3
4
5
6
7
8
9
SOS
10
1 is Thriving, 10 is SOS
What have you tried so far to fix this?
Diet changes
Exercise routines
Supplements or vitamins
Detox programs
Medication
Therapies or coaching
Fad diets
GLP1 or off-label diabetes injections
None
Other
Why do you think those things did not work long term?
How is this struggle affecting your life right now?
Reduced energy and motivation
Impact on family relationships
Work productivity decline
Mental health challenges
Physical discomfort or pain
Social withdrawal
Financial stress
Other
If nothing changes in the next 6-12 months, what do you think happens?
What results are you hoping for?
What matters most to you right now?
Improved energy and vitality
Weight loss and body composition
Mental clarity and focus
Better sleep quality
Emotional balance
Long-term health and longevity
Other
What support do you feel you need most to follow through?
Accountability coaching
Personalized meal plans
Exercise guidance
Mindset and motivation support
Stress management techniques
Community support
Other
What current habits or patterns hold you back the most?
Are you ready for a true Metabolic Reset?
If there was a proven path that burns fat, protects 98% of your lean muscle, and reverses metabolic dysfunction, how open are you to following it exactly as designed?
Very open and committed
Somewhat open, need more info
Not sure yet
Not open at all
Are you prepared to invest time, energy, and money into your health if the plan fits you?
Yes
Yes but need details
Not right now
If accepted, how soon would you want to start?
Right away
This week
Within the next two weeks
Anything else you want me to know before I review your application?
Please drop the link to your Facebook or Instagram if you have one!
Submit
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