Birthdate: January 1
Education: College Graduate
Family Info (spouse, kids, pets):
How do you feel about yourself, your weight, your decision to change?
How long have you been overweight?
What things have you tried before to lose the weight?
What is the number one reason you want to lose weight?
What are some other reasons?
What is your goal weight?
What is the first thing you want to do when you reach your goal?
Are the people closest to you supportive? If not, why?
What is the worst thing about being overweight?
What is the best thing about you?
How will losing weight affect those around you?
On a scale of 1 to 10 (low to high) how determined are you to reach your goal? 10