Free Weightloss Consultation:

Take this 10 question survey for your customized weightloss plan.

1) When following a weight loss program or diet I often…

  • Follow the protocol perfectly


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    Follow the protocol most times
  • Have trouble following for the entire recommended time
  • Do not follow it after a few days

2) In the next 6 to 8 weeks I would like to lose…

  • 10-15 lbs
  • 16-25 lbs
  • 26-35 lbs
  • Over 35 lbs

3) Most weight loss programs say that exercise can help improve results, I find incorporating exercise can be…

  • Easy for me
  • Somewhat difficult
  • Very hard for me
  • Almost impossible

4) My lifestyle could be described as…

  • Active at home and work

  • Active at work and inactive at home
  • Inactive at work but active at home
  • Inactive at both work and home

5) People in my family tend to have the following body type…

  • Very lean
  • Lean and muscular
  • Muscular but with a higher body fat %
  • High body fat %

6) Unwanted fat tends to be found on my…

  • Abdomen
  • Abdomen, and hips and butt
  • Abdomen, hips, thighs, and butt
  • Everywhere

7) I eat fast food and other high fat foods…

  • About once a month
  • About once a week
  • About once a day
  • Sometimes more than once a day

8) My practice of eating breakfast best fits the following description…

  • Healthy breakfast every day
  • Breakfast every day
  • Skip breakfast once in a while
  • Skip breakfast often

9) Pertaining to stress, which of the following best describes you…

  • I am stress free at work and home
  • I have a little stress but deal with it well
  • I have trouble dealing with stress
  • I extremely affected by stress in my life

10) I am _____ Years old.

  • 18-25
  • 25-35
  • 35-45
  • 45+


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