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Are You a Candidate for Weight Loss Surgery?
Take our 60 Second Assessment to Find Out.
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Infusionsoft Tags
Nurture Subscriber
New Lead
New Customer
Interest - Email Series
Myself
Clean List
Email Typos
Completed - Assessment
Started Personalized Assessment Followup - Website
Started Personalized Assessment Followup - Email
Started Personalized Assessment Followup - Staff Email Footer
Started Personalized Assessment Followup - Optin Monster
Started Personalized Assessment Followup - Facebook
Started Personalized Assessment Followup - Google Ads
Started Personalized Assessment Followup - All Sources Combined
Ended Personalized Assessment Followup
Completed - Surgery
Completed - Consultation
Submitted Form from Website - NonAssessment Lead
Scheduled - Consultation
Started - The "Warm Fuzzies" Welcome System
Started Long-Term Pre-Op Nurture
Requested - Info
Started The "Never-Ending Post-Op Care" System
Clicked link - Patient - from Hubspot Export on 1-13-19
Started Personalized Assessment Followup - Hubspot Lead
Exported from Hubspot - 1-13-19 - from April
1/16/2019 3:08 PM
Started - Hubspot Reengagement - 1-17-19
Requested - Consultation
Requested Info - From Website
Requested Info - All Sources Combined
No-Showed - Consultation
Follow Up In Future - Consultation
Timing Not Right - Longterm Followup
Clicked in email - Requested - Consultation
Exported from Hubspot - 1-18-19 - from Haley
1/19/2019 12:12 PM
Cancelled - Consultation
Reporting - Completed - Assessment - 01-2019
Reporting - Requested - Consultation - 01-2019
Reporting - Scheduled - Consultation - 01-2019
Reporting - Completed - Consultation - 01-2019
Reporting - Completed - Surgery - 01- 2019
Reporting - Completed - Surgery - 01- 2019
No Longer Interested
New Referral Lead
test
Test - Start Campaign
Clicked - No Longer Want to Receive Reminders for Scheduling Consult
Temp - Accidentally Restarted Part 1
Temp - Start 3 day delay
Temp - Active in Part 2
Duplicate Contacts
Reporting - Completed - Assessment - 02-2019
Reporting - Requested - Consultation - 02-2019
Reporting - Scheduled - Consultation - 02-2019
Reporting - Completed - Consultation - 02-2019
Reporting - Completed - Surgery - 02-2019
Clicked link - Patient - from Hubspot Export on 3-6-19
Started - Hubspot Reengagement - 3-6-19
Imported - Old Leads - Sarah SaleAMP - 3-6-19
3/07/2019 9:26 AM
Clicked - Not Sure - Follow up 1 week
Clicked - Not Sure - Follow up 2 weeks
Clicked - Not Sure - Follow up 1 month
Clicked - Not Sure - Follow up 3 months
Clicked - Not sure - Not Interested in Moving Forward
Clicked - Not Sure - Yes Ready to Move Forward
Test - Not Sure Flow
test - for mike
Test - Start Campaign 2
Completed - Consultation - Originally Not Sure - Now Moving Forward
Test - Success Story
Temp - 3-12-19 - Completed Assessment
Test - Request consult
Registered for Zoom Webinar
Attended Zoom Webinar
Reporting - Completed - Assessment - 03-2019
Reporting - Requested - Consultation - 03-2019
Reporting - Scheduled - Consultation - 03-2019
Reporting - Completed - Consultation - 03-2019
test - create email 2- wedeliver
Jotform -> Submitted Jotform - BMI of Texas - Share Your Story
test - trigger success story
Start - Post-op - Encouragement Emails
Email2 NOT set up – WeDeliver Optin - Postop Campaign
Clicked in email - Insurance Deadline Broadcast - Requested - Consultation
Reporting - Completed - Assessment - 04-2019
Reporting - Requested - Consultation - 04-2019
Reporting - Scheduled - Consultation - 04-2019
Reporting - Completed - Consultation - 04-2019
Ended - 5 Day Sales Sequence
Reporting - Requested - Consultation - 05-2019
Reporting - Completed - Assessment - 05-2019
Reporting - Scheduled - Consultation - 05-2019
Reporting - Completed - Consultation - 05-2019
Ended - Part 2 - SPWNS
Started - Post-op Campaign
Tagged - Other or Balloon - Ask for Review
Reporting - Completed - Assessment - 06-2019
Reporting - Requested - Consultation - 06-2019
Reporting - Scheduled - Consultation - 06-2019
Reporting - Completed - Consultation - 06-2019
Temp - Old Hubspot Leads Who Didn't Engage
Reporting - Completed - Assessment - 07-2019
Reporting - Requested - Consultation - 07-2019
Reporting - Scheduled - Consultation - 07-2019
Reporting - Completed - Consultation - 07-2019
Temp - remove from dietary - 8-13
Reporting - Completed - Consultation - 08-2019
Reporting - Completed - Assessment - 08-2019
Reporting - Requested - Consultation - 08-2019
Reporting - Scheduled - Consultation - 08-2019
Temp - scheduled - consult - 9-24
Temp - cancelled consult - 9-24-19
Temp - no showed consult - 9-24-19
Reporting - Completed - Assessment - 09-2019
Reporting - Requested - Consultation - 09-2019
Reporting - Scheduled - Consultation - 09-2019
Reporting - Completed - Consultation - 09-2019
Requested - Consultation - Submitted Web Form
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utm_source
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utm_medium
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utm_campaign
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I am...
Male
Female
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Do you struggle to maintain a healthy weight using only diet and exercise?
Yes
No
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Do you suffer from any of these health issues?
Select all that apply. Then select "Next."
Heartburn / Acid Reflux
High Blood Pressure
Sleep Apnea
Diabetes
Joint/Bone Issues
Depression
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Hidden: Convert Height to Total Inches
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Hidden: BMI Calculator
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What is your height and weight?
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This field is required.
Enter your height and weight below.
Weight (lbs)
Height (ft)
Height (in)
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What is your biggest challenge or question right now?
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Select one from below.
Can I afford it?
Is surgery right for me?
Will I keep the weight off long-term?
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Which payment option describes you best?
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Select one from the below.
Self-Pay / Financing
Private Insurance
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15
Have you decided which treatment is right for you?
Select one from below. If you are not sure yet, that is perfectly fine. Just select "Not Sure Yet"
Not Sure Yet
Gastric Bypass
Gastric Sleeve
Duodenal Switch
Obalon Balloon
Medically Supervised Weight Loss Program
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16
Where are you in your Weight Loss Surgery decision process?
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This field is required.
Step 1. Researching
Step 2. Evaluating Treatments
Step 3. Choosing my Doctor
Step 4. Ready to Book a Consult
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Thanks! Where can we send your results?
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Enter your information below to receive your Personalized Results. You will also receive an Email Course about your weight loss options from BMI of Texas in San Antonio, Texas. We keep your information safe and private. This Assessment is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. By providing your cell phone number you agree to receive calls and texts to that number from BMI of Texas.
First Name
Last Name
Email
Phone
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Email
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Phone
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First Name
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Last Name
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Date of Submission
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Date
Month
Day
Year
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Medical Weight Loss
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24
Value 1
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25
Infusionsoft Tags
Nurture Subscriber
New Lead
New Customer
Interest - Email Series
Myself
Clean List
Email Typos
Completed - Assessment
Started Personalized Assessment Followup - Website
Started Personalized Assessment Followup - Email
Started Personalized Assessment Followup - Staff Email Footer
Started Personalized Assessment Followup - Optin Monster
Started Personalized Assessment Followup - Facebook
Started Personalized Assessment Followup - Google Ads
Started Personalized Assessment Followup - All Sources Combined
Ended Personalized Assessment Followup
Completed - Surgery
Completed - Consultation
Submitted Form from Website - NonAssessment Lead
Scheduled - Consultation
Started - The "Warm Fuzzies" Welcome System
Started Long-Term Pre-Op Nurture
Requested - Info
Started The "Never-Ending Post-Op Care" System
Clicked link - Patient - from Hubspot Export on 1-13-19
Started Personalized Assessment Followup - Hubspot Lead
Exported from Hubspot - 1-13-19 - from April
1/16/2019 3:08 PM
Started - Hubspot Reengagement - 1-17-19
Requested - Consultation
Requested Info - From Website
Requested Info - All Sources Combined
No-Showed - Consultation
Follow Up In Future - Consultation
Timing Not Right - Longterm Followup
Clicked in email - Requested - Consultation
Exported from Hubspot - 1-18-19 - from Haley
1/19/2019 12:12 PM
Cancelled - Consultation
Reporting - Completed - Assessment - 01-2019
Reporting - Requested - Consultation - 01-2019
Reporting - Scheduled - Consultation - 01-2019
Reporting - Completed - Consultation - 01-2019
Reporting - Completed - Surgery - 01- 2019
Reporting - Completed - Surgery - 01- 2019
No Longer Interested
New Referral Lead
test
Test - Start Campaign
Clicked - No Longer Want to Receive Reminders for Scheduling Consult
Temp - Accidentally Restarted Part 1
Temp - Start 3 day delay
Temp - Active in Part 2
Duplicate Contacts
Reporting - Completed - Assessment - 02-2019
Reporting - Requested - Consultation - 02-2019
Reporting - Scheduled - Consultation - 02-2019
Reporting - Completed - Consultation - 02-2019
Reporting - Completed - Surgery - 02-2019
Clicked link - Patient - from Hubspot Export on 3-6-19
Started - Hubspot Reengagement - 3-6-19
Imported - Old Leads - Sarah SaleAMP - 3-6-19
3/07/2019 9:26 AM
Clicked - Not Sure - Follow up 1 week
Clicked - Not Sure - Follow up 2 weeks
Clicked - Not Sure - Follow up 1 month
Clicked - Not Sure - Follow up 3 months
Clicked - Not sure - Not Interested in Moving Forward
Clicked - Not Sure - Yes Ready to Move Forward
Test - Not Sure Flow
test - for mike
Test - Start Campaign 2
Completed - Consultation - Originally Not Sure - Now Moving Forward
Test - Success Story
Temp - 3-12-19 - Completed Assessment
Test - Request consult
Registered for Zoom Webinar
Attended Zoom Webinar
Reporting - Completed - Assessment - 03-2019
Reporting - Requested - Consultation - 03-2019
Reporting - Scheduled - Consultation - 03-2019
Reporting - Completed - Consultation - 03-2019
test - create email 2- wedeliver
Jotform -> Submitted Jotform - BMI of Texas - Share Your Story
test - trigger success story
Start - Post-op - Encouragement Emails
Email2 NOT set up – WeDeliver Optin - Postop Campaign
Clicked in email - Insurance Deadline Broadcast - Requested - Consultation
Reporting - Completed - Assessment - 04-2019
Reporting - Requested - Consultation - 04-2019
Reporting - Scheduled - Consultation - 04-2019
Reporting - Completed - Consultation - 04-2019
Ended - 5 Day Sales Sequence
Reporting - Requested - Consultation - 05-2019
Reporting - Completed - Assessment - 05-2019
Reporting - Scheduled - Consultation - 05-2019
Reporting - Completed - Consultation - 05-2019
Ended - Part 2 - SPWNS
Started - Post-op Campaign
Tagged - Other or Balloon - Ask for Review
Reporting - Completed - Assessment - 06-2019
Reporting - Requested - Consultation - 06-2019
Reporting - Scheduled - Consultation - 06-2019
Reporting - Completed - Consultation - 06-2019
Temp - Old Hubspot Leads Who Didn't Engage
Reporting - Completed - Assessment - 07-2019
Reporting - Requested - Consultation - 07-2019
Reporting - Scheduled - Consultation - 07-2019
Reporting - Completed - Consultation - 07-2019
Temp - remove from dietary - 8-13
Reporting - Completed - Consultation - 08-2019
Reporting - Completed - Assessment - 08-2019
Reporting - Requested - Consultation - 08-2019
Reporting - Scheduled - Consultation - 08-2019
Temp - scheduled - consult - 9-24
Temp - cancelled consult - 9-24-19
Temp - no showed consult - 9-24-19
Reporting - Completed - Assessment - 09-2019
Reporting - Requested - Consultation - 09-2019
Reporting - Scheduled - Consultation - 09-2019
Reporting - Completed - Consultation - 09-2019
Requested - Consultation - Submitted Web Form
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