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Habit Reform
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Nutrifit
Nutrifit
Take the Readiness Test
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NUTRIFIT
Take the Readiness Test
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What is your dieting history?
*
I never dieted before
I dieted less than 3 times
I tried all the diets on earth
Every time I lost weight I put all back on again
How extensive is your food and nutrition knowledge?
I know exactly what I should or shouldn’t eat
I am confused with all the conflicting information out there
I feel like I need to learn more
I have the knowledge but no inspiration
What does your relationship with food look like?
I live to eat, not eat to live
I hate thinking and worrying about food
I think about food all the time
I eat when stressed, bored, sad….
Define your support system?
No one understands me
People around me are very supportive
I don’t like talking to others about my weight
Everybody is pressurizing me to do something about my weight
How do you feel about your weight loss at the moment?
Desperate to lose
Ready to commit
Scared to fail
Despondent
What is your relationship with alcohol like ? (you can chose more than 1)
I drink daily
I am a social drinker
I binge drink occasionally
I don’t drink
Please specify how much weight you need to lose.
Name
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First
Last
Email
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Any additional comments?
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