Weight Loss/Nutrition Personalised Programme

"Miss meals,  really like sugary foods, sensitive to carbs. ,energy levels etc??.."

 

This questionnaire has been designed to establish your personal requirements. Please answer all of the questions below by ticking the appropriate box. Serious enquiries only please from over 18s. If under 18 please ask your parents to complete.

What are your challenges? Feeling hungry, tired, eating too many or too few calories, not enough protein, too many carbs and wrong kinds of carbs, not drinking enough water, etc Suggest you  these links before completing the questionnaire. Are you getting the right protein intake? What are your key challenges?

Experienced consultants are available to offer one to one advice.

The way we work
1. Identify with you, your key challenges
2. Suggest a recommended programme
3. Provide ongoing advice by phone and email as required

This way we get results...and have hundreds of thousands of thank you letters on file across 58 countries.

1.Which of these best describes your own lifestyle?

Calm Active Stressed

2.Do you think you get 100%of the daily nutrition needed for good health?

Yes No Sometimes

3.Do you take nutritional supplements (vitamins/minerals/proteins)

Daily Never Sometimes

4.Do you experience a loss of vitality during the day? Give details

YesNo Occasionally

5. Do you eat 3 meals a day?

Yes No

.6.If no, which meal/meals do you miss.

 

7.Can you run through a typical daily diet:

Breakfast e.g. cereal/toast
Mid morning e.g. fruit, chocolate bar
Lunch
Mid afternoon
Dinner
After dinner

7a.Irregular meals or eat late? Please give details

8.Do you smoke?

Yes No

9. Sweet tooth?

Like sugary foods/chocolate

Really like sugary snacks

Really, really like sugary snacks! (e.g. multiple choc bars)

Don't like sugary snacks

Other snack consumption

10. How much still water to you drink each day?

3+ litres

2+litres

1+ litre

odd glass

Fizzy drink consumption? :

11.Any food groups you cant consume? Please give details

12.Any health challenges? IBS, Diabetes, Arthritis, sleep problems, high cholesterol, heart disease etc etc

13.Body shape (click on link to see illustrations)

Lower

Upper

Proportionate

14.Sensitivity to carbohydrates

You have more than 10lbs to lose and you tend to carry your excess weight around your middle rather than all over? (i.e. an "upper" body type affects 20% of population)

Yes  No

Are you sensitive to excessive carbohydrate intake? Do you crave bread, pasta, rice, snack foods and sweet treats

Yes No

Do you find you are not content with just one biscuit, but take another, and another

Yes No

Do you feel tired after carbohydrate- rich meals (bread, pasta, rice, potatoes?

Yes No

Would you describe carbohydrate--rich foods as a "weakness" in your diet?

Yes No

15. You have less than 10lbs to lose but those stubborn inches are on hips, thighs & bum

Yes No

16.What type of work do you do i.e. sedentary, active, at home

17. Do you know your fat content?

18. How have you tried to lose weight before? You may select more than one

Counting calories or points

Low fat diets

Low carb / high protein

Meal replacement drinks

Other (please specify)

19.Your obstacles to weight loss

Snacking

Slow metabolism

Poor nutrition through dieting

Low energy

Don't know

Other challenges (please specify).

20. What has caused your weight gain? If known

21.What is your weight loss goal?

0-3 lbs
4-7 lbs
8-14 lbs
14-28 lbs
28 lbs +

22..When are you looking to lose the weight by?

23.Why do you want to lose weight?

To look good
To have more self-confidence
For health reasons
I'm going on holiday
I'm attending a special event
Other (please specify)

24.How much do you spend on breakfast, lunch, snacks and fizzy drinks? (exclude evening meal)

Less than £1.00 per day
£2.00                        
£3.00                                             
£4.00                         
£5.00

25How much are you prepared to spend per day to achieve your goal?

Less than £1.00
£2.00                         "I couldn't believe the money I saved on my food bill
£3.00                       using this programme. I saved money on lunch and snacks and soft drinks"                         
£4.00                          Jenny Talkington, Wiltshire
£5.00

26.How old are you?

27.How tall are you?

28.Approx weight?

29.What is your ideal goal ?

30.How serious would you say you are about your losing weight?

    1. Extremely serious              
    2. Fairly serious                    
    3. It doesn't really worry me   

31. How serious would you say you are about maintaining long term good health by looking after your body now?

    1. Extremely serious              
    2. Fairly serious                    
    3. It doesn’t really worry me   

32. Would you benefit from weekly advice by phone or email?

Yes

No

33. Information required e.g. I have questions I need answering/ general advice /personalised programme.

34. Which areas of interest?:

Increasing nutrient and protein intake. Feed the body not starve it

Thermojetics, supporting the metabolism

Herbal Supplements -better absorption of nutrients, detox, cleansing

Boosting vitality

Name 

Telephone Evening 

Telephone Day

Email

How did you make contact with us? did  some one refer you, advertising, search engine, poster etc

Best time to call Telephone consultations between 9am -9 pm on landline telephones. And on Saturday between 10-4pm. If your "hard to contact" or don't have a  landline number call us on 01932 889236 .Contact us at least 30 mins after completing the questionnaire.

Which part of the country are you from? County or nearest large town?

Please check your contact details or we cant help you! Please check that you have completed information required box.

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