Your Health Starting Point with Dani Gantt

Your Goals, My Mission: Let’s Get Started 💪🏼

Hello and welcome! 😊 I’m Danielle, and first off, I want to say a big KUDOS TO YOU for taking the time to fill out this short questionnaire. You’re one step closer to achieving your goals! By sharing your insights, I’ll be able to customize a program specifically designed for you.Six years ago, I found myself in a similar position—nervous about reaching out to someone I barely knew, discussing a vulnerable topic, and worried I might waste money on another program that wouldn’t work. I felt ashamed of my circumstances, unhealthy, and frustrated that I couldn’t find a solution on my own. As a single mom of three, I was struggling with my health, feeling exhausted, lacking direction, and living paycheck to paycheck. Sound familiar?What motivated me to take action was my growing frustration with my own excuses and the fear of staying on a dead-end path. Plus, I couldn’t help but notice someone I knew experiencing a remarkable transformation, which gave me a serious case of FOMO! Looking back, I’m incredibly grateful I decided to make that phone call. It truly felt like I was given a second chance at life! Now, I’m thriving in my 40s instead of just surviving. I’ve had the privilege of helping over 12,000 people discover their health and wellness, and I would love to support you on your journey, too!
What is your full Name 😊

First NameLast Name
E-mail address:
example@example.com
Best number to reach you at:
Format: (000) 000-0000.
Today's Date:

MonthDayYear
Date
Your Current Age:
How did you hear about me or my program? If it was through a friend, I’d love to know their name! I truly appreciate referrals and offer credits to my clients for them!
What is your current weight and height? If you’re like me and prefer to avoid the scale, how much do you estimate you weigh? 😉
Phone Number:
How would you rate your overall health at the moment—Excellent, Good, Fair, or Poor? Consider aspects like physical, mental, emotional health, energy levels, confidence, and fitness.
What’s your motivation for wanting to lose weight? Perhaps you’re looking to gain muscle or improve your health habits? Understanding your strong ‘why’ is crucial!
What other programs or strategies have you previously tried to lose weight or adopt a healthier lifestyle? What alternatives are you currently exploring?
What do your ideal weight, health, and activity goals look like?
What changes would you make in your life at this moment to enhance it?
BMI
What is the BMI value for the weight you want to maintain at?
Medical
Are you currently on any medications, such as those for thyroid issues, anxiety, depression, cholesterol, blood pressure, diabetes, or weight loss? None of these disqualify you; they may just influence how I can best assist you!
Are you currently being treated for any of the following?

Other
Are you.....
Sleep
How is your quality of sleep, and do you wake up feeling rested?
How many hours of sleep do you typically get?
What time do you go to bed, and what time do you wake up?
Hydration
How much water do you drink each day?
Do you consume any other beverages?
Motion
How would you rate your daily energy level on a scale of 1 (lowest) to 10 (highest)?
Do you currently exercise? If so, how many times a week?
What physical activities or exercise do you participate in?
How would you describe your daily activity level?
If you are active or have an exercise routine, do you take any supplements, such as vitamins, amino acids, protein powder, creatine, or electrolytes?
Stress
How would you rate your stress level on a scale of 1-10?
What is your occupation?
Do you have any additional stressors in your life? Our programs emphasize both a healthy body and a healthy mind! In fact, cultivating a positive mindset is our top priority, as it significantly impacts overall well-being!
Eating Habits
How many meals per day do you eat?
Do you snack in between meals? If so, what snacks?
How many days a week do you dine out or get food on the go? This includes coffee runs, fast food, sit-down restaurants, takeout, vending machines, etc.
Current Weight: (if you want to share)
Height:
In an ideal scenario where failure isn't an option, how many pounds would you like to lose to enhance your self-esteem?
What has been the most difficult thing about losing weight in the past?
Is there anyone in your life who would like to get healthy with you? If so, who?
I have complete faith in the effectiveness of the programs I provide! You are truly the only variable that can influence the success of these scientifically designed programs. While the program is straightforward, it may not always be easy—just like anything worthwhile in life. However, with my support, I am confident that you can shed the weight, achieve consistent transformation, and develop healthy habits for a lifetime! Let’s embark on this journey together! I’m thrilled to work with you!
Address (I work with people all over the country)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you feel you learn better by:
On a scale of 1 to 10, how ready are you to make changes to improve your health?

1

2

3

4

5

6

7

8

9

10

1 is Just thinking about it, 10 is Ready to do this
If you’re interested in scheduling a follow-up call to discuss your health goals and explore which programs may suit you best, please don’t hesitate to use this link to set up a time to chat. No pressure—just a friendly conversation!

https://calendly.com/danigantt/questions
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