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Weightloss Quiz
1. How many times have you tried to lose weight in the past?
Never
1-4 times
5-10 times
More than 10 times
2. Why do you want to lose weight?
Improve my health
I want to look fitter (low body fat percentage and high lean muscle mass)
Increase my energy levels
Increase my life expectancy
All of the above
3. What have you tried to lose weight in the past? (multi select)
Diet
Exercise
Medications
Surgery
4. How much weight do you want to lose? (Patients may lose up 15-25% of their body weight)
5kg
10kg
15kg
20kg
30kg
More than 30kg
5. Over what timeframe do you want to lose this body weight?
3 months
6 months
9 months
12 months
24 months
6. Are you prepared to make lifestyle changes (diet and exercise) as part of a weight loss program to achieve these results?
Yes
No
7. Are you looking for overall sustainable weight and lifestyle change or a quick fix?
Quick fix
Sustainable long term weight change
8. Do you have a social support network (family and friends) that will support you on this journey?
Yes
No
9. A medical weight management program will cost $399 per month. Is this within your budget?
Yes
No
10. Would you like a free call with our nursing team to discuss how the program works and how to get started?
Yes
No
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