Make a commitment to yourself...and your success.

Congratulations on taking the first step toward a lifestyle change...one that puts you on the road to better health and well -being!

Below is a helpful list of things to discuss with your doctor when talking about weight-loss options. Fill it out and click the submit button at the bottom of the page. You'll then see a page that you can print out and take with you to your doctor.

PLEASE NOTE: When you leave this site, the information you've entered here will not be stored or captured. Therefore, you might want to print out an extra copy of this page for your records.

My BMI is  

My height is ft in

My weight is

 

Here are the weight-loss goals I have for myself:
 

I'd like to lose: 10-20 lbs 21-40 lbs Over 40 lbs please choose

I'd like to improve my health.

I'd like to look better.

I'd like to get down to a size

 

Here's how I feel about myself and my weight right now:

 
Here are the weight-loss methods I've tried in the past, and my feelings about them:

Reduced -Calorie Diet

Reduced -Carbohydrate Diet

Reduced -Fat Diet

Diet Programs and Support Groups

Physical Activity

Over -the -Counter Diet Pills

Prescription Weight -Loss Medications

 

Use the space below to expand on your experiences with the weight-loss methods you've tried:

 
Here are my current medical conditions or illnesses (as well as conditions that run in my family):

Diabetes

Heart Attack

Congestive Heart Failure

Stroke

Arthritis

Asthma

Cancer

High Cholesterol

 

I currently take part in physical activity:

Every Day Three or more times a week Once a week Once or twice a month Never please choose

Here's a list of my physical constraints:

 
I'm interested in exploring the following weight-loss options:

A Healthy Eating Plan

Increased Physical Activity

Prescription Medications

 

Here are some questions I have about weight loss: