| Are you at least 80 pounds overweight? |
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| Do you have any of the following conditions: diabetes, hypertension, GERD (heartburn or reflux), arthritis in weight-bearing joints (knees, ankles, hips, back), high cholesterol, sleep apnea or infertility? |
| Yes No |
| Does your weight stop you from doing activities you enjoy? |
| Yes No |
| Can you comply with long-term, life-long dietary changes? |
| Yes No |
| Are you interested in learning more about surgical weight loss or bariatric medical weight management (can be an option for individuals who are 10-75 pounds overweight)? |
| Yes No |
| Enter your current BMI: |
Use the calculator below to find out your current BMI.
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| How did you hear about or find this assessment? |
| If possible, provide more detail as to how you found us: |
