Weight Loss Pre-Consultation

Your Contact Details

Your Name(Required)
Your Address(Required)
DD slash MM slash YYYY
If you don't know the BMI please revert to the weight loss page and complete the ready reckoner

Weight Loss Assessment

In your past efforts to lose weight, in what ways were you successful ?(Required)
In your past efforts to lose weight, what were you motivated by?(Required)
In your past efforts to lose weight, what sources of support did you rely on?(Required)
If I lost some weight, some changes I would see would be…(Required)
What is motivating you to consider a change now?(Required)
Everyone measures success differently. How do you think you’ll measure weight-management success?(Required)
Check off the items you most agree with (choose 4) on the following checklist(Required)

How Can We Reach You?