GLP1 Assessment

Take our free GLP1 Assessment – all answers kept 100% confidential.

Personal information

Name(Required)
MM slash DD slash YYYY
State of Residency(Required)

Assessment

I consider myself to be:
My parents or siblings are overweight or obese:
I think about food a lot:
When I eat I never seem to feel full:
My hunger and cravings for food are difficult to control:
I binge eat (I eat more than 5,000 calories in one sitting) more than once a month:
My favorite snack food is:
I tend to eat and snack a lot at night:
I feel guilty when I overeat:
I crave foods that are high in carbohydrates and/or high in fat:
When I am eating with friends or co-workers I eat less and leave hungry because I do not want people to know how much I eat:
I hate seeing myself naked:
When I am anxious, I turn to food for comfort:
I have worked with a nutritionist before:
I have tried numerous diets:
My BMI is:
I have had surgery for weight loss:
I have the following (check any that apply):

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