Interested in starting an Optavia plan? Looking for a coach? Just want to learn more? Let's talk! Just fill this out what you want in the form below & I'll reach out to you! 

Name *

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Last

Email *

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Right now, how much do you weigh? If you were like me and didnt get on the scale, how much do you think you weigh?

What would your dream health/weight goals look like?

Do you exercise?

Are you being treated for any of the following?

• Gout
• Type 1 Diabetes
• Type 2 Diabetes
• Thyroid Disease
• High Blood Pressure
• High Cholesterol
• Other

Are you…..

• Pregnant
• Nursing

On a scale of 1-10, how committed are you to getting to your health goals? *

What would you change about your life right now to make it better?

Preferred Method of Me Reaching Out! *

• Email
• Phone Call
• Text

Anything else you want me to know?

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