Are you overweight?
Slightly
A Lot
Just need to get in shape a little
How do you feel about your weight while you’re around other people?
Awkward
Insecure
Anxious
Ashamed
I feel fine
How do you feel mentally when by yourself?
Sluggish
Confused
Stressed
I feel fine
How do you feel physically?
Tired
Painful
Out of Breath
Sweaty
Lazy
Hungry
Foot Pain
Nauseous
How much weight have you gained in the last 3 months:
in kgs
How much weight have you lost in the last 3 months:
in kgs
Why did you gain weight?
Overeating
Depression
Traumatic Event
Stress - Emotional Eating
I don't know
What are your biggest temptations?
Grocery Shopping
Social Drinking
Food Delivery
Family Eating
Fast Food
Why do you want to lose weight?
To get healthier
To look better
To get rid of a health problem
To feel better
Why do you want to lose weight?
Enter your reason here...
Do you need an analysis from Dr. Narindr?
Yes
No
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