Question 2/12

What do you do to lose or maintain your weight?

Question 3/12

How do you rate your weight?

Question 4/12

Have you ever gone to a doctor about your weight/diet?

Question 5/12

What do you consider the most important factor in losing weight

Question 6/12

What do you consider to be your next step in weightloss?

Question 7/12

Do you currently suffer from any of the following ailments? (click all that apply)

Question 8/12

What cosmetic procedure would you consider for weightloss?

Question 9/12

Do you currently have medical insurance?

Yes
No

Question 10/12

Please select your current medical provider

Question 11/12

What is the name of your provider?

Question 12/12

lease select the current medical coverage you have