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Dietary Assessment

Welcome to Weight Loss Warriors and our "breakthrough" weight loss system where you can not only lose weight and keep the pounds from ever returning, but also become more lean, healthy & energetic in the process.

Please visit our website at www.weightlosswarriors.com to learn more about the diet plan that everyone is talking about and how you can join in the action.

Please answer the following questions about your health and weight. We will analyze the information you submit and create a special report to help you start losing weight right away.

Your report will be available "on-line" immediately after submitting the questionnaire and a copy will also be sent to your email so that you will have it for future reference.

How would you describe your fitness?
Better than average    Average    Worst than average   
   
What is your goal?
Lose more than 10 pounds Lose less than 10 pounds
Stay at my current weight Eat healthier foods
   
What do other people think about your weight?
No idea Need to lose weight About right
   
Do you think about your weight often?
Yes No
   
How often do you snack in between meals?
All the time Occasionally Seldom
   
Your height: feet inches
   
Your current weight: pounds
   
Your target weight: pounds
   
Your gender: male female
   
Your age: years
   
Your activity level: