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Weight Optimization Questionnaire

Weight Optimization Questionnaire

Step 1 of 3

Individual Readiness for Change Questionnaire

This questionnaire is designed to help you and your doctor decide if this is a good time in your life for you to begin a weight management program. Just be as honest with yourself and your doctor as you can and circle the answers you feel most apply to you.

1. Do you feel motivated to lose excess body fat at this time?(Required)
2. How motivated are you to change your eating habits at this time?(Required)
3. How motivated are you to increase your physical activity at this time?(Required)
4. How motivated are you to try new strategies/techniques for changing your Dietary, physical activity and other health related behaviors at this time?(Required)