Your Health Starting Point w/ Coach Jessica
First, I want to tell you that you are gorgeous and worthy! Size is not what makes that true. Getting healthy is the true goal! Weight loss is simply a side effect of learning new habits for long-term health. You will be amazed at what’s possible in just weeks! ~Jessica Sneed
What is your full name?
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First Name
Last Name
What is your best email?
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example@example.com
What is your mobile phone number?
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Please enter a valid phone number.
How did you hear about Coach Jessica Sneed?
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Include group name or referral name
Right now, how much do you weigh? If you were like me and didn’t get on a scale, how much do you think you weigh?
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Right now, how would you describe your overall health? Physical, mental, energy, self confidence…
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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!)
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What would your dream health/weight goals look like?
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. Share away...
Women…Are you:
Pregnant
Nursing
Perimenopause
In Menopause
Postmenopause
Are you being treated for any of the following?
Gout
Type 1 Diabetes
Type 2 Diabetes
Thyroid Disease
High Blood Pressure
High Cholesterol
Heart Complications
PCOS
Other (explain below)
Do you have any other medical history you think would be relevant to your health journey?
If you marked “Other” above, please explain here.
Describe the quality of your sleep?
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How many times do you currently eat per day?
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Include snacks and desserts.
How much do you spend on groceries & eating out per month? Approximately the portion that’s for YOU only.
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(For example, if you have a family of four, divide your monthly food budget by 4…vary this based on the ages of your kids and how much they consume ;)
Do you exercise?
Briefly describe frequency and intensity.
How many pounds are you away from feeling confident?
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If you’re confident at any size, how many pounds are you away from your initial weight loss goal? ;)
How many weight loss options have you tried? It’s normal to try several or many and think nothing else will work (it will!)
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I’ve never tried to lose weight before
1-3
4-6
6-10
I’ve tried everything
Are you currently taking or considering taking GLP-1 weight loss injections? It’s important to have a nutrition component with the injections.
Currently taking
Considering taking
Not applicable
On a scale of 1-5 (with 5 being ready today), how committed are you to getting to your health goals?
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Just Curious
1
2
3
4
I’m Committed!
5
1 is Just Curious, 5 is I’m Committed!
I am totally confident in the program and its ability to work. Literally, you are the only variable to the program’s 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 coaching. With you being the only variable: if you fail or if you succeed, it’s your choice. 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 about having control over something that will help you get healthy?
I can’t wait to connect with you!
Thank you for being vulnerable here and letting me into your corner so I can cheer you on! I’ll be in touch.
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