Weight Loss Assessment Survey

Your gender is?

Your age is?

Your BMI is? (Use our Home page calculator if needed)

Your height in feet and inches is?


Do you find it difficult to maintain a healthy weight using only diet and exercise?

Do you suffer from any of these health issues?

What is your biggest challenge or question right now?

Have you decided on a treatment yet?

At what step are you in your decision making process?

Comments or questions?