Weight Management Pre-assessment Form

Weight Management Online
Pre-assessment Form

Please be aware that it is important to give truthful information about your medical history.

For example: abnormal heart rhythms, heart disease, heart attack, heart failure etc.

For example: goiter, Graves' disease, hypothyroid, hyperthyroid etc.

For example: inflammatory bowel disease or gastroparesis etc?

For example: anxiety, depression, schizophrenia, personality disorders, thoughts of suicide etc.

For example: anorexia, bulimia, binge eating etc.?

Smoking increases the risk of serious health issues. You can find more information about quitting here.

Excessive alcohol consumption can increase the risk of serious health issues. To get help with cutting down drinking, visit this page.

NB. It is very important to stay hydrated when taking this medication in order to reduce potential constipation

Lack of sleep can affect two important hunger hormones, (ghrelin and leptin) making you feel hungry and increasing your appetite.

NB. This doesn't have to be set time in the gym, it can be ANY activity that gets your heart pumping. (Current guidelines recommend 150 minutes of moderate aerobic activity or 75 minutes vigorous activity per week)