Have you tried any weight loss programs in the past? *

Yes

No

What is your biggest challenge with weight loss? *

Lack of motivation

Struggles with diet

No time for exercise

Medical conditions affecting weight loss

How often do you exercise *

Daily

3-4 times per week

1-2 times per week

Rarely or never

Do you have any dietary restrictions? *

Yes

No

Do you consume sugary drinks or alcohol regularly? *

Yes

No

Are you willing to make long-term lifestyle changes for weight loss? *

Yes

No

How soon do you want to start a weight loss program? *

Immediately

Within the next month

In the future, but not ready yet

Not sure

Are you open to professional guidance such as nutritionists, personal trainers, or medical weight loss programs? *

Yes

No

What type of weight loss support are you most interested in? *

Personalized coaching

Meal planning & nutrition guidance

Fitness training & workout programs

Medical weight loss options

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