This is your personal Health & Weight-loss Awareness Assessment

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Hey Friend,
WelcomeI ! Welcome! I am so glad your are here!

Aren't you just so tired of walking to your closet with the dread of what will I wear today? We go the dark color section don't we or to the "cover up" clothes?
How about the paralyizing feeling of stepping on to the doctors scale? Don't you just want to stand on it backwards?
How about that old bathing suit in your drawer that says, "DONT EVEN THINK ABOUT IT!"
Then we step into the family photo MOMENT like we are getting a mug shot taken. TERROR! We also hide behind everyone, thats IF we even get in it? Sound familiar?
How about the conversation in the mirror? Hmmmm...Who needs enemies at this point, we've found every flaw and found new names for ourselves by this point?
How about with trying those 50 different diets hoping this is the one and guess what, you weigh more now then you ever did?
It's not an easy place to be is it? It can be down right disheartening to where you don't even want to go out of your house, let alone mingle or work in front of people.
Has that been your journey?
LET'S GET UNSTUCK SHALL WE?

My Friend, my goal is to AWAKEN you to your TRUE SELF and to DIAL into what you really WANT. That way we can come up with your plan of lasting SUCCESS! Doesn't it sound like FUN to have a new story finally?

Set aside 5-10 minutes to fill this out
LETS TAKE A JOURNEY TOGETHER
I am so excited to partner up with you to create your success story.

Feel free to call me at 814.977.7818
As my gift for you, you will recieve a weekly email full of tips and a variety of recipes to assist you in making this best decision of your life!

Tammy Taylor

LET'S GET REAL INTENTIONAL TOGETHER! (GRIT)

By answering these questions, you agree that you are not following any medical advice and that there is no medical advice being offered. This form is not in any designed for diagnosis.
Disclaimer to all stories posted:
Average weight loss on the Optimal Weight 5 & 1 Plan® is 12 pounds. Clients are in weight loss, on average, for 12 weeks.

Email *

Name: *

Phone Number *

My story: I lost 50# I less than 6 months! I have Thyroid issues, I had high blood pressure, along with an autoimmune disease, liver issues, heart and more...I was also at a point in my life 5 years ago that I was working 16 hour days and 6 part time jobs. BUT GUESS WHAT? I have the passion to succeed! I want this for me! I want this for you I WANT TO LIVE! I WANT TO MAKE A DIFFERENCE IN MY LIFE AND IN EVERYONE ELSE'S LIFE AROUND ME! I have been coaching for over 16 years but the last 5 have been the game changer in my body, mind and finances. Now it's your turn..

How many pounds would you like to lose? *

1-20 Derek wanted better eating habits even though he was fit to lose a few pounds

21-50 Diabetic, in his 70s playing guitar, planting gardens and living his life

50-100 Stephanie Sugar Addict (Was pre diabetic, had fallen arches) Riding horses

101-200 Tami lost over 100# in less than a year (High Blood Pressure & dad died young of heart issues)

201+ Britt Lost 336# in 2 years! She suffered with being over weight from youth into her 20s

Required

Do you deal with any of these issues? *

Diabetes

Thyroid

Pain

High Blood Pressure

Other

If other please explain:

Alice has dealt with weight issues since she was little! She has tried over 30 diets! Her whole life has changed!

What is your relationship with food? Check and trigger foods below *

Sugar

Alcohol

Carbs (breads, pastas, cakes, cookies)

Soda

Sweetened Tea

Caffeine

Salt

Chocolate

None

Other

Required

If other please explain:

I even helped my momma jump on the healthy train! Who in your life would also benefit from creating a healthy life.

From 1-10 How COMMITTED are you to improving your health & weight? *

Kind of

ALL IN! LET'S DO THIS!

What is Your Biggest Fear or What Holds You Back? *

Failing

Succeeding

None

Other

Required

Please Explain: *

Jesse a busy dad of 3 who works full time. My AWESOME son! He lost 30# in 7 weeks!

How fulfilled in life are you?

Not at all

I feel like I am living my dreams!

Clear selection

Please Explain: *

Couples changing & setting an amazing example for their family. Wendy & Ryan are rocking their health even 4 years later!

Tell me how active you are! Check all that apply *

Walk 1-3 Days a week

Walk 4-7 Days a week

I am a runner

I do cardio classes weekly

I lift weights 3-5 days a week

High Intensity

Low Intensity

Yoga or Stretch

None

Other

Required

Fill me in on the other:

Fireman Rick is dialed into living a healthy life. He is very active and wants to live a long life. He deals with high blood pressure and is a single dad striving to be the best version of himself.

Rate Your Energy Level Below: *

No energy or zest for life

BOOM Feet hit the floor running

Do you have an of the following food allergies? *

Soy

Gluten

Fruit

Sea food

Nuts

None

Other

If other please explain:

Emotional Health Check off any that apply *

Anxiety

Stress

Low Self Worth

Self Judgement

Depression

Happy and excited about life

Do not wish to disclose

Other

Rae could not hardly get out of her chair when I met her. She is diabetic and decided she wanted to live. She is out working on her pool, garden and play with her grandkids now. So exciting!