Busy Bariatrics

Bariatric Optimization Quiz

I am so excited to help you optimize your metabolism after bariatric surgery! Please answer these questions with as much detail as possible so I can help. Once the application is received we will be reaching out via text to set up an appointment to review your results.

Personal Information

First Name

Last Name

Phone *

Email *

Date of birth

Gender

Height (inches)

Weight

Primary Goals

Activity level

Health issues or physical limitations that might limit your ability to follow the plan

Have you been consuming 1200 calories or less in the past 6 months? (If so, please let us know for how long)

Are you currently tracking calories and/or macros? If so, please give us your current calorie and macro targets.

Currently how many days a week are you doing cardio?

Currently how many days a week are you strength training?

Are you currently doing any mobility work? Yoga/Pilates/Bare etc?

What do you do to destress yourself?

How would you describe your quality and quantity of sleep on average?

How many alcoholic beverages do you consume on average per week?

How many ounces of water do you consistently drink a day

Please give us a detailed explanation of your current eating habits and what you think you do well and what you think you struggle with the most?

What are your non-negotiables? (think of aspects of your life that you prefer not to give up-social events, date nights, family dinners out, etc.)

What do you do for work? Would you describe it as a relatively sedentary job or a high activity job?

Do you currently meal prep or plan any of your meals for the week? Do you enjoy cooking, meal prepping/planning?

How would you describe your hunger levels throughout the day?

Do you have any health concerns or hormonal concerns that you would like your coach to know about?

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