Please take your time and answer the questions, the more you share, the more value you will get out of our future nutrition and lifestyle recommendations. (For instance, a slow metabolism requires a different nutrition than a fast one.) // After I review I will be in touch. / Because I get back to each person individually and I currently receive a lot of messages, the reply can take up to 14 days. // THIS INFORMATION IS CONFIDENTIAL and will only be reviewed by Jennifer Witte.
1) Do you think it's easy for you to lose weight?
Yes, I easily lose weight.
I don't know. I guess it's not too hard for me.
No, it's hard to lose weight.
No, it's hard to lose weight or even to keep my weight stable.
2) Has your weight been stable for at least three months (includes a variation of ± 3 kg/6 lbs)? Note: If you don't weigh yourself: Great! Please make a guess.
Yes, my weight has been stable. (--> Continue with question 3)
No, during the last three months I have gained at least 3 kilos. (--> Continue with question 4)
No, during the last three months I have lost at least 3 kilos. (--> Continue with question 4)
My weight is going up and down. (--> Continue with question 4)
3) For how long has your weight been stable (includes a variation of ± 3 kg/6 lbs)? Note: If you don't weigh yourself, make a guess. (Skip this question if you answered the previous with "no" or "up and down")
For more than three months and less than six months.
For more than six months and less than a year.
For more than a year.
4) Have you ever tried diets or just limiting calories in order to lose weight?
Yes. (--> Continue with question 5)
No. (--> Continue with question 7)
5) Have you ever dieted or limit the calories for more than 14 days in a row? (Note: Skip this question and continue with number 7 if your answer was "No" in the previous question.)
Yes, and one of these phases was during the last 3 months.
Yes, and one of these phases was 3 to 6 months ago.
Yes, and one of these phases was 6 to 12 months ago.
Yes, but that's more than one year ago.
No, I've never stuck to it for more than 14 days. (Continue with question 7)
6) How many diets or low calorie phases have you done so far?
1 to 3
3 to 6
More than 6
7) How regular is your bowel movement? (No diarrhea; Please choose "other" and describe if you have digestive issues)
Mostly more than once a day.
Once a day.
About every second day.
Every third day or less.
8) How often do you exercise for at least 30 minutes? (Medium to high intensity)
5 to 6 times per week.
4 to 5 times per week.
2 to 3 times per week.
Once a week or less.
9) On average, how many of your meals come with veggies or fruits?
About 2/3 of my meals.
About half of my meals.
About 1/3 of my meals.
Less than 1/3 of my meals.
What's your goal? Please describe it as detailed as possible.
On a scale of 1-10, how ready are you to commit to yourself, your growth and your life and working with a coaching?
Is there something else that you'd like to share with me? (diseases, intolerance, etc.)
How did you find out about me?
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