Busy Bariatrics Application

for our

Bari-Bestiez Friends

We are so excited to welcome our friends from Bari-Bestiez into the Hive! We can't wait to help you THRIVE on your journey!

First Name

Last Name

Phone *

Email *

Instagram Username

How did you hear about Busy Bariatrics?

Do you agree to push through your fears, show up for yourself, and commit to the opportunity you have in front of you?

Yes

On a scale of 1-5 how ready are you to make this goal a reality? 1 being you aren't and 5 being I want to start tomorrow!

What has been your biggest challenge to facing your goals?

Describe your perfect outcome? What would you have to accomplish with your body, health, and fitness to say you've "accomplished" your biggest goal after bariatric surgery?

What have you already tried to reach this goal?

How much do you have budgeted monthly for coaching services?

Do you feel you are able to make a decision on joining the program on your own?

Yes

Will you need a significant other involved in your decision making? (totally cool if so we can set up a joint call!)

Yes

What type of weight loss surgery have you had?

I am considering weight loss surgery

Gastric banding (Lab Band)

RNY (Gastric Bypass)

Vertical Sleeve Gastrectomy (VSG)

I am not considering weight loss surgery

What is the one thing you would like me to know about you prior to our meeting?

By checking this box, I consent to receive non-marketing text messages from Busy Bariatrics, LLC. Message frequency varies, message & data rates may apply. Text HELP for assistance, reply STOP to opt out.

By checking this box, I consent to receive marketing and promotional messages including special offers, discounts, new product updates among others.from Busy Bariatrics, LLC at the phone number provided. Frequency may vary. Message & data rates may apply. Text HELP for assistance, reply STOP to opt out.