Selected Value: 0
1 is unhealthy - 10 healthy
Selected Value: 0
1 is low - 10 high
Selected Value: 0
1 is low - 10 high
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1 is low - 10 high
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1 is low - 10 high
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1 is low - 10 high
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1 is poor - 10 good
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1 is poor - 10 No symptoms
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1 is low - 10 High
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Please read the following carefully and sign above if you agree: We are not a medical organisation and the information and reports generated by us should not be interpreted as a substitute for a medical consultation. Nothing contained in the programme should be construed as medical advice or diagnosis. It is your responsibility to determine, What would you like to achieve: Health Weight Fitness By when? Do you have a specific goal in mind? What are your top 3 reasons for wanting to change now? What are the top 5 most important things to you in your life? List all the advantages of you achieving your goals now. How will your life improve? Please provide details of other healthy eating regimes you have tried What usually gets in the way of your success / what are your barriers? How can you overcome these barriers? What are your biggest concerns regarding your health / weight? What is the best way to support you? What do you most need? What are your hobbies – what do you love doing? What other areas of your life would you like to improve? On a scale of 1 (low) to 10 (high) how important is it for you to be: Healthier: Slimmer: Fitter: On a scale of 1 (low) to 10 (high) how committed do you feel towards your goals? through obtaining appropriate medical advice, that you are fit and well and that such contents and services are suitable for you. It is not our responsibility to do so. Please seek advice from your doctor if you're in any way concerned about your health, you are very overweight, before commencing any exercise regime, if you have an existing medical condition that could be affected by dieting, if you believe you have an eating disorder, or if you are pregnant or planning a pregnancy. The programme is not intended for those under the age of 18 without consent from a parent, doctor or guardian.