If yes, please explain.

How often do you exercise?

What type of exercise?

If yes, please explain.

Please answer the following questions honestly so we can do our best to help you reach your goals.

What changed that caused the weight gain (if anything)

What's the main reason you are seeking treatment at this time?

What are your goals about weight control and management?

What do you consider your ideal weight?

When was the last time you were at your ideal weight?

How much weight do you want to lose?

How many times a year do you diet?

What is the hardest part about managing your weight?

What have you tried in the past that has failed?

Weight loss questionnaire.