Client DISCOVERY Form:
Name
*
First Name
Last Name
Phone Number
*
E-mail
example@example.com
Birth Month & Day :)
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How did you hear about us?
If you were referred by a Trainer, do you give us permission to share information with each other to help you with your success?
Please Select
Yes
No
Does not Apply
Select one or more reasons of why it has been difficult for you to have the lifestyle change you desire?
Lack of Time
Lack of Motivation/Discipline
Lack of Family/Friend Support
Lack of Systems
Lack of Healthy Meal Ideas
What is your health goal?
What have you tried before?
Why is it important for you to reach that goal?
Finish this sentence: I know I will be able to meet my goals as long as I am ________ and _________.
What will you be able to accomplish?
When did you last feel your best?
Do you have any dietary restrictions? If so, please state them below.
Thank you so much for being a part of "Optionz! with Eliza"! Eliza will contact you to set up a 2-3 minute conversation to discover what you need the most help with and to see if we align. It's a two-way interview and an opportunity for you to ask me any questions you wish. I'm here to help people get results. 971.450.8580
"Everything Tastes Better with Optionz!"
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