Weight Loss Survey
In order to learn about the challenges you face with losing weight, I would greatly appreciate responses to the questions below.
All of these questions are OPTIONAL.

In one of the questions, you will need your BMI. If you don't know it, calculate it here: bit.ly/mybmicalc. Just input your height and weight. It will tell you your BMI. Open the link in another tab so that you don't lose this page.
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Name
Email
Phone
Age (totally optional)
Sex (totally optional)
How much weight would you like to lose?
Why do you want/need to lose weight at this time?
On a scale of 1-5, how important is it to you to lose weight?
Not Terribly Important
Really Important
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Do you have any medical conditions that are causing you concern?
Note: Gina Carr is NOT a doctor, dietician, or nutritionist. She does not provide medical advice. She recommends that you speak to a medical professional before undertaking any change in your normal routine.
How long has your weight been an issue for you?
Do you know your Body Mass Index (BMI)? If so, please put it here.
If not, you can calculate it here: bit.ly/mybmicalc. Just input your height and weight. It will tell you your BMI.
What kinds of diets or programs have you tried in the past? What results did you have?
What is the biggest thing that keeps you from losing weight?
If you could lose the weight you want, how much better would your life be?
A Little Bit Better
Life Changing Better
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What will help you most in this course?
What do you think will be your biggest obstacle in losing weight this time?
What is your current exercise routine?
What are your favorite foods? What do you eat several times a week?
Is there anything else you would like to share?
Where did you hear about this course?
Click as many as are relevant. If friend/podcast, etc., please explain - who, what, etc? Thanks so much!
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Submit
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