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Weight Control Quiz
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Weight Control
Assessment
Weight Control Assessment
1.
Do you want to lose weight?
Yes
Not Sure
No
2.
Have your recently found that changing your diet or working out more is not helping you lose weight?
Yes
Not Sure
No
3.
Have you tried diets previously where you lost some weight and then gained it back and then some?
Yes
Not Sure
No
4.
Have you recently experienced a loss of energy?
Yes
Not Sure
No
5.
Is your current weight affecting your self-esteem?
Yes
Not Sure
No
6.
Do you currently feel that you have control over your weight?
Yes
Not Sure
No
7.
Do you feel frustrated and depressed with your recent attempts to lose weight and to keep it off?
Yes
Not Sure
No
8.
Are you interested in a weight control program that is individualized just for you and focused on your lifestyle?
Yes
Not Sure
No
9.
If you could learn “how to eat” to not only get the weight off but keep the weight off, would you be willing to put in the work needed?
Yes
Not Sure
No
10.
Are you ready to take the next step towards the “new you”?
Yes
Not Sure
No
Your Full Name
To what email address may we send your results?
Enter your phone # if you would like us to call you to discuss your results.
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