Preferred Method of Contact: Phone:
Are you Pregnant? Are you nursing? If yes, how old is your baby?
Note: All text in 'italics' are meant to be read out-loud to Clients.
High Blood Pressure
Coumadin (Warfarin)
Other medications:
*Lithium: The healthcare provider may wish to adjust frequency of lab work for the
Client and monitor.
Thyroid Medications: The healthcare provider may wish to monitor thyroid
hormone levels while the Client is on the Program and adjust medication.
Coumadin (Warfarin): The healthcare provider may wish to review food choices,
conduct lab work and/or adjust medication.
Tell me about your health:
Do you have any allergies or medical conditions that could influence which Program we choose?*
*Reminder: We recommend that Clients contact their healthcare provider before starting and throughout their weight loss journey.
Can you tell me about a time in your life when you were healthier? What has changed between then and now?
Yes YesNO NO
What is your main motivation for wanting to make
changes to your health?
(Relationships, activities,
how you will feel, etc.)
Share YOUR story (or someone elses).
Take 90 seconds or less to share the pieces of
your story or a Client’s story that will connect
with this person.
Are you taking any
medications for:
Now that you've shared some of your current health
goals, I want to give you a quick idea of what is possible.
High Blood Pressure
Diabetes Type I
Diabetes Type II
Gluten Intolerance or
Soy Allergy or
Food Allergies
Do you have the following:
I would love to hear what you would like to
accomplish with your health.
(Weight loss, improved
sleep, better response to stress, etc.)
6 8
"Its great speaking with you today and Im excited to see if I can assist you with your goals. Before we can determine if one of our
Programs is right for you, Id like to ask you a few questions to learn about you and your health goals. Does that sound good?"
Remember: If a Client answers affirmatively to any
of the questions to the left, consult the 'Health
Assessment Guidelines: OPTAVIA Program
Considerations' page before suggesting a Program.
How many hours of sleep do you get in a typical night?
How would you describe the quality of your sleep?
On a scale of 1-10, what is your energy level throughout the day?
How would you describe the quantity & quality of the activity you
do each week?
How many hours a day do you sit?
How many days a week do you exercise? (0 - 7 days)
What types of physical activity do you enjoy?
On a scale of 1-10, how fulfilled are you?
On a scale of 1-10, how much do you worry?
What area of your life tends to be the biggest stress for you?
What do you do for work?
On a scale of 1-10, how much do you enjoy what you do?
How many meals and snacks do you eat per day?
When do you eat your first meal of the day?
How many times a week do you eat out? And where?
How many ounces of water do you drink per day?
Do you drink other beverages? Coee, soda, alcohol, tea, etc.
If so, how often and how much?
Are you comfortable sharing your age?
How tall are you?
How much do you currently weigh?
What would you consider to be a healthy weight for you?
Have you tried to lose weight in the past?
What has been diicult for you about losing and maintaining
On a scale of 1-10, how healthy would you rate your surroundings?
(Does this person have healthy and active friends, supportive
family, keep junk food in the house, etc.)
Is there anyone in your life who would like to get
healthy with you?
Is there anything else you think I should know about your health?
NEXT STEP: Refer to the 'Health Assessment Guidelines: Sharing Script'
STEP o2: DAILY ROUTINE & HABITS CLIENT Tracking Information:
Time Zone:
Gender: Age:
Current Weight: Current BMI:
Desired Weight: Desired BMI:
Healthy Weight Range:
HEALTH Assessment Date:
Order Date: Start Date:
Starting Weight:
How did we meet?
Lead Referral Of:
Coach Checklist:
Recommend Client consult their Healthcare Provider before
starting a Program
Confirm receipt of Client's Welcome Email (Before & After,
Measurements and Guide)
Send friend request via Facebook, add to Facebook Support Group
and welcome them
Send Journey Kick-Off Video and Confirm video was viewed BEFORE you
have a brief night before conversation
Add Client to your Newsletter
Set up daily support messages (virtual or text)
Invite to weekly support calls
Teach Client on how to refer others
Send OPTAVIA Premier Order Video when 7 day reminder email comes
Coach TIPS:
As your Client begins their journey to optimal wellbeing,
they may feel hungry, tired, or irritable as their body
adjusts to a new way of eating. While adjusting to intake
of a lower-calorie level and diet changes, some people
may experience temporary lightheadedness, dizziness or
gastrointestinal disturbances.
When speaking to your Clients, here are a few additional
tips to make the adjustment period easier into fat
burning for your Clients.
You can remind them to:
Download and use the Habits
of Health® App to track their
Fuelings and water intake.
Stay hydrated with water.*
Consider choosing a start date
when you don’t expect any
social food-centered events.
Stay busy.
Approach their health journey,
one day at a time.
Open up Your LifeBook, put
your name in it & read the
introduction, once in a fat
burning state.
Avoid temptations, and stay
focused on your health goals.
Sip on 1 cup of broth or eat 2 dill
pickle spears (as needed in the
first few days). If Client has no
sodium restrictions.
Wait to start exercising for 2 – 3
weeks on the Optimal Weight
5 & 1 Plan®. We recommend
checking with your doctor
before starting any exercise
*We recommend drinking 64 ounces of
water each day. Talk with your healthcare
provider prior to changing the amount
of water you drink as it can aect certain
health conditions and medications.
Thank you for sharing, now I'd like to tell you how
our Program could help you achieve your goals.
Date Notes:
Journey Kick-Off
Day One Check-In
Day Two Check-In
Day Three Check-In
Day Four Check-In
Day seven Check-in
Tips for working
with new Clients:
Week 2 Check-In
Week 3 Check-In
Week 4 Check-In
Remember to continue to check-in with your Client from Day 7 onward
Please use the following pages to continue your check-ins. Confirm a weekly check-in day.
Place their completed Health Assessment in Section 2 – ‘New Clients’ folder.
Make sure you have your weekly check-ins with your New Clients, discuss their Health
Assessment with them and make a note of their progress.
Set a Client Support day during the week and graduate all Week 1 - Clients to that day’s
schedule moving forward.
Once a Client has been on their Program for one month, move them to
Section 3 – ‘Active Clients' folder.
Ask them: "Have you shared your success with anyone? Are people asking you about your transformation?"
When that happens, you can refer those people to me and receive "X" (if you choose to do a referral program on your own to
thank people for referrals, please discuss with your Business Coach). Or, because people often prefer to be coached by their
friends and family, you may want to consider coaching them yourself. A signiicant percentage of our Coaches were Clients
irst who became healthy and then decided to “pay it forward.”
Week 2 Check-In
Week 3 Check-In
Week 4 Check-In
Date Notes:
Week 5 Check-In
Week 6 Check-In
Week 7 Check-In
Week 8 Check-In
Week 9 Check-In
Week 10 Check-In
Week 11 Check-In
Week 12 Check-In
CONTINUE check-ins with your active clients to assist them on their journey
Through our habits of health
transformational system.
Blank 'Client Check-In Trackers' are available for download on COACHANSWERS.OPTAVIA.COM
Health Assessment