This questionnaire has been designed to establish your personal requirements for gaining weight. Please answer all of the questions below by ticking the appropriate box.

Serious enquiries only please. This is not a diet plan. Experienced consultants, from the worlds largest weight management company, available to offer advice by telephone.

1.What are your meal patterns like 

3 meals a day

More than 3 meals a day

Irregular meals

Less than 3 meals a day

2.Food consumed. Do you

Eat lots of food and not put on weight

Have a poor appetite

3.Current diet?

Breakfast e.g. cereal/toast

Mid morning e.g. fruit, chocolate bar

Lunch

Mid afternoon

Dinner

After dinner

4.What are your energy levels like

Below average

Average

Above average

5. Do you smoke?

Yes No

6.Give yourself a rating on negative nutrition (smoking, coffee drinking, fast food, processed food, stress, medication) out of 10. High negative nutrition = low number.

7.How have you tried to gain weight before? If so how?

8.Do you play sports or exercise or go to the gym? Please advise details

9.What type of work do you do ie office work or physically demanding work?

10.How old are you?

11.How tall are you?

12How much do you weigh?

13.How long have you been at this weight

14.What is your ideal goal weight?

15.Addditional information e.g. general health:

16.How much would you be prepared to spend per day to achieve your goal?

Less than £1.00

£2.00

£3.00

£4.00

£5.00

17.How serious would you say you are about your gaining weight?

1. Extremely serious              
2. Fairly serious                    
3. It doesn't really worry me   

18.How serious would you say you are about maintaining long term good health by looking after your body now?

1. Extremely serious              
2. Fairly serious                    
3. It doesn’t really worry me   

Information required Recommended programme? Questions you need answering? Anything not clear on the web site?

Name 

Email 

Telephone Evening 

Telephone Day

Mobile

Best time to call Telephone consultations between 9am -9 pm on landline telephones

Please check your contact details or we cant help you. Please check that you have completed the information required box