BEING OVERWEIGHT CAN BE A PHYSICAL AND EMOTIONAL STRUGGLE

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LOSE WEIGHT - FEEL GREAT - AND IMPROVE YOUR HEALTH

Start here, I'm a...

Male

Female

What is your body type?

Block

Hourglass

Pear

Round

Triangle

What part of your body worries you the most?

Full - Mid section

Torso - Upper Body

Waist Line and Flanks

What is your body type? - Female

Block

Hourglass

Pear

Round

Triangle

What part of your body worries you most? - Female

Belly - Mid Section

Hips, Buttocks and Thighs

Lower body and Legs

How old are you?

Between 18 and 30 years old

Between 31 and 45 years old

45 years old or over

How much weight do you need to lose?

10 Pounds or less

10 to 20 Pounds

20 Pounds or more

What is your daily activity level?

Inactive – very little daily activity

Light – desk job with occasional walks

Moderate – active job or regular exercise

Active – Intense daily activity or exercise

What's the biggest struggle you face when it comes to losing weight?

I procrastinate

My lifestyle makes it hard to eat right

Diets are too hard to stick with

I have craving and am always hungry when dieting

Do you suffer from any of these issues?

Low self-esteem - I don’t feel good about myself

I don’t like the way my clothes fit

I don’t feel attractive

I need to lose weight for my Health

What is your reason or motivation for wanting to lose weight now?

I want to look and feel my best

Getting Married

Going on vacation / Getting ready for the beach

An important person in my life wants me to lose weight

Which time of the day do you feel the most tired?

Early to mid-morning

After lunch to mid afternoon

After dinner

Not until bedtime

Lastly, this may not seem like it matters, but "How many hours do you sleep at night?

Less than 6 or 7 hours most nights

7 or 8 hours every night

More that 8 hours at least 4 nights per week

Full Name *

Email *

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