Welcome to your Weight Loss Profile
This short assessment is designed to help you and your healthcare provider better
understand your eating habits and what motivates you to manage your weight.
By answering honestly, you’ll gain insights into your challenges with appetite and
your personal reasons for wanting to lose weight. There are no right or wrong
answers—just what’s true for you. Let’s get started!
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Have you tried other weight management
therapies in the past?
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How do you prefer to
take medications?
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What is your main reason for wanting to lose weight?
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Do you have any of the
following medical conditions?
(Check all that apply)
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Do you get strong cravings or
eat when feeling emotional?
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What emotions most often trigger you to eat?
(Check all that apply)
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How often do you find yourself eating or
snacking, even if you’re not physically hungry?
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After finishing a meal, how often do you feel
satisfied and able to stop eating?
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Please Answer all Questions
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