Hi! I'm Shelly and I coach a plan that helped me lose over 80 lbs and keep it off for 6+ years now ending a 3 decades of struggle. Now I get to help others break free too. I'm so glad you're here! Help me get to know you by filling is out and clicking submit.
What's your name?
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
Right now, how much do you weigh and how tall are you? If you were like me and didn't get on the scale, how much do you think you weigh?
Right now, how would you describe your overall health? 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 (Because you can. Big boned is a lie we tell ourselves..)
What would your dream health/weight goals look like? Close your eyes and really give this some thought. Give me specifics.
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. I knew credit card debt was a problem before I started losing weight. Marriage and finances can be big reasons why we eat and drank, and I get it. Share away...
How old are you?
Are you being treated for any of the following?
Gout
Type I Diabetes
Type II Diabetes
Thyroid Disease
High Blood Pressure
High Cholesterol
Heart Complications
GLP-1
Other
Any medicines? Thyroid, Anxiety, Depression or Off Label Diabetes Injections?
Are you...
Pregnant
Nursing
Pre Menopause
Post Menopause
Rate your current sleep health on a scale from 1-10, 1 being no sleep to 10 being the best sleep you've ever had.
How many meals do you currently eat per day?
Do you exercise?
How many pounds away are you from feeling confident?
How many other weight loss programs have you tried? Lord knows I tried so many!
On a scale of 1-10, how committed are you to getting to your health goals?
Do you have any troubles in your relationship or marriage right now that you want to share? I pride myself on being very transparent. My weight used to really make me self conscious which impacted my marriage and intimacy was non-existent.
I am 100% confident in the program and its ability to work for everyone. Literally, you are the only variable to the programs 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 help, but with you being the only variable, if you fail, it's your fault, if you succeed it's 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!
Preview PDF
Continue Later
Submit
Should be Empty: