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

If a person weighs 65 kg and the person's height is 165 cm (1.65 m), the BMI is calculated as 65 ÷ (1.65)2 = 23.87 kg/m2
How important is it for you to maintain a fresh, natural facial appearance during your weightloss journey?(Required)
Select one
Which of the following skinrelated goals are important to you during weight loss?(Required)
Select Your Top 3
In your past efforts to lose weight, in what ways were you successful ?(Required)
Select as many answers as apply to you
In your past efforts to lose weight, what were you motivated by?(Required)
Select as many answers as apply to you
In your past efforts to lose weight, what sources of support did you rely on?(Required)
Select as many answers as apply to you
If I lost some weight, some changes I would see would be…(Required)
Select as many answers as apply to you
What is motivating you to consider a change now?(Required)
Select as many answers as apply to you
Everyone measures success differently. How do you think you’ll measure weight-management success?(Required)
Select as many answers as apply to you
Check off the items you most agree with (Please choose your top 4) on the following checklist(Required)

How Can We Reach You?