Weight Wellness Test


Take a few seconds to answer these questions so we can evaluate your weight loss journey and give you information as soon as possible in an email.



Please answer the following questions as accurate as possible.

How long have you attempted to lose weight?

Which of these weight-loss systems have you tried before? (check all that apply)

South Beach DietWeight WatchersAtkins/Paleo/Low CarbTried eating less on my ownNutriSystemExercise DVDMedifastNutritionist GuideHerbal Diet/SupplementsJenny CraigPersonal TrainerHypnosis

What factors make you want to lose weight? (check all that apply)

I'd like to look better for myselfI'd like to look better because of someone elseI'd like to get healthierI'd like to get more energyI'd like to get control over my bodyI'd like to live my life againI'd like to feel a sense of accomplishmentI'd like to be happy picking out clothes

Why do you think your previous weight-loss attempts were unsuccessful? (check all that apply)

I lost weight - but then gained it backLack of motivation to exerciseUnable to exercise after injuryDiet support was lackingDidn't like being hungry all the timeToo much work for little resultsDifficult to decide the right foodsCan't stop eating and/or cheat on diets

How did you hear about us?

EmailOnline AdKOCO Channel 5Search EngineTwitterFacebookExisting Patient

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