Health & Wellness History
Are you currently under the care of a Primary Care Physician?*
Please Tell Us Your Level Of Stress On A Regular Basis, 1 Being Lowest, 10 Being Highest*
Do You Suffer From Uncontrollable Cravings?*
Do You Find Yourself Eating Due To Emotions?*
Do You Feel Tired Or Out Of Energy?*
Has Your Doctor Advised You To Lose Weight?*
Have You Ever Been On A Weight Loss Program Before?*
Have You Ever Tried Medications And/Or Diet Supplements For Weight Loss?*
Does Your Weight Cause You Physical Pain?*
How Often Do You Eat Fast Food?*
Describe Your Activity Level*
Does Your Family Support Your Weight Loss Efforts?*
Are You Currently Breastfeeding?*
