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How many diet programs have you followed in the last 12 months?
1 to 3
3 to 5
What is your #1 health goal right now?
Burn fat, lose weight, and get into shape?
Build lots of lean muscle?
I am planning for a youthful future and want to eat a healthy, balanced diet
Which of the following four body types best describes you?
Slim through the shoulders and torso with muscular or naturally thicker bum & thighs
Long & Lean:
I had difficulty gaining weight in my younger years
Sturdy, stocky frame that is naturally strong
Inverted Triangle Shaped:
Relatively slim through my waist and hips but bulkier up top through the arms and shoulders
What's preventing you from having your ideal body now?
Confused as to what I should do
I don't exercise enough
Poor diet habits
I can't stay consistent
Along with energy crashes, mood swings kick in. How's your mood on a typical day?
I'm generally in a good mood throughout the day
I'm often irritable or short with others
I experience mood swings, feel occasionally blue and depressed
How is your energy day to day?
I typically maintain a steady energy level throughout the day
I typically maintain a steady energy level but feel myself dragging before meals
I experience a post-lunch slump in energy
How you process food can have tremendous impact on weight loss results. Do you experience stomach discomfort?
Rarely, once a month or less
Twice a week or more
How many pounds do you need to lose, to reach your desired weight and body shape?
More than 21 pounds
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