WEIGHT MANAGEMENT QUIZ

Section A

About You.

First Name

Last Name

Phone / Whatsapp Number

Current height and weight (or rough BMI if known)

What is your main goal?

Section B

Health & Safety Screen

Are you currently pregnant, breastfeeding, or trying to conceive?

Yes

"For your safety and your baby's, we'd love to support you properly. Please book a free consultation with us first."

Do you have any of these conditions?

Diabetes 1 & 2

Eating disorder (past or present)

Thyroid disorder

Kidney or liver condition

An existing condition not listed

None of these

Are you taking any regular medication?

Any allergies or intolerances?

Are you currently using any weight-loss treatments? (tick all that apply)

Slimming teas or drops

Prescription pens / injections (e.g. GLP-1)

Supplements / over-the-counter products

Diet / exercise programme only

Nothing right now

If you’re on something now, what exactly are you using?

Have you tried weight treatments before? What worked / didn’t?

Section C

What You Want.

Do you have ongoing issues with food, appetite or diet you’d like help managing?

Yes - I’d like professional guidance

No - just want a product

What kind of support are you looking for?

A professional plan / guidance from a dietitian

A prescription-style treatment (pens)

A product or bundle I can buy and start now