Survey

If you have, or are currently working on your weight, please fill out and submit the form below.   All names will be kept confidential.  Click here if you want to return to the home page. 

Thank you.

Name:
Email Address:
Age
If you have already lost weight, how much weight have you lost and how long have you kept it off?
When and how did you first realize you were overweight?
Was there a period of time between realizing you were overweight and doing something about it? If so, what was this time period like for you?
What made you decide to lose weight?
How did you lose weight?
Did you have setbacks during your weight loss phase? Some people experience plateaus or even some weight gain during this phase. How was it for you?
What do you currently do to maintain your weight loss?
If you have kept the weight off for 3 years or more, do you find it gets easier with time?
May I contact you for more information? Yes
No

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