Health questionnaire

Welcome!

I have prepared some questions for you to reflect, and answer for me. They will help us to define the starting point, what your goal is, and what the best way for you shall look like.

Take all the time you need to answer the questions, choose a quiet place, and write honestly. Nothing you write is right or wrong, there is no judgment on your feedback. It is rather a good exercise to think about and reflect on your current situation and the steps to follow.

Let´s get started!

Diana

Full name *

Email *

Age

Your current weight is...

My waist circumference is... *

The abdominal circumferene can be easily measured with a tape as follows: You stand up with your feet together, your arms at your sides and your abdomen relaxed, then wrap the measuring tape around your belly at the navel level. Without pressing, you take a deep breath and immediately take the air out.

Describe to me in a couple of lines what is it, that does not make you feel good (lack of energy, overweight, stress, fatigue, boredom, etc.) *

Any health problems you are aware of? *

What are the diets or regimens that you have tried so far? What was your experience did you have? *

Are you more interested in losing weight or rather in learning how to eat and live healthily? Or both? :) *

When you think about improving your lifestyle and eating healthy, what is the feeling that comes over you? Do you feel you can succeed? *

My biggest problem or weakness is ... *

I want to change and improve my health because ... *

Thanks for taking the time!

I will get back to you as soon as possible.

Diana