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Location : 1 Springwood Ave, Narre Warren VIC 3805
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Weight Control Program Online Assessment
This assessment takes 5 mins to complete
Male
Female
Your height(cm)
Your current weight(Kg)
Your waist(cm)
Are the parents obese?
Yes
No
Did the parents lose weight successfully?
Yes
No
Which of the snacking would you like to take?
Between-Meal Snacking.
Late-Night Snacking.
Boredom Eating.
Stress Eating.
None Of These.
Is portion control difficult for you?
Yes
No
Sometimes
Do you have a lot of soft drinks, chips, cookies, sweets, high calorie/deep fried food, high protein food, etc ?
Yes
No
Sometimes
How much time do you spend sitting a day?
Yes, I Sit All Day
No, I’M On My Feet All Day
Most Of My Day
Somewhat, I Moved Around
What exercise do you like most?
Strength Training
Taichi/Yoga
Running
Walking
None Of These
How many days a week do you take exercise?
7
5-6
2-4
0-1
How long do you move throughout the day?
More Than 60 Mins
Up To 60 Mins
15-30 Mins
0-15 Mins
How many hours do you sleep a night averagely?
More Than 9 Hours
7-9 Hours
5-6 Hours
Less Than 5 Hours
How’s your sleeping?
Easy To Fall Asleep
Difficult To Fall Asleep
Wake Up Throughout The Night
Sleep Through The Night
Are you tired during the day?
Always Tired
Sleep All Day
In Need Of A Nap
Not Very Tired
Energised
What is your typical meal?
Sandwich
Soup And Salad
How many meals do you have?
3 Meals
Over 3 Meals
3 Meals + Snack
2 Meals
What is your portion?
Big
Average
Small
Do you like beer?
Everyday
Usually
Occasionally
Do you feel thirsty normally?
Yes
No
What temperature of water would you like when you feel thirty?
Warm
Cold
Room Temperature
How many times of urine a day?
More Than 5 Times
Less Than 5 Times
What colour of your urine except the morning first urine?
Dark Yellow
Light Yellow
Clear
How many times of pooping a day?
Once
Twice
More Than 3 Times
None Of These. Constipated
What shape of your poo?
In Form Of A Log And Soft
In Form Of A Log And Hard
Soft And Broken
How do you feel your tummy normally?
Comfortable
Uncomfortable
Do you have acid reflux recently?
Yes
No
Sometimes
Do you have bad breath?
Yes
No
Sometimes
Do you have serious back problem?
Yes
No
Do you have following risks?
Heart Disease
Hypertension
Diabetes
Non-Alcoholic Steatohepatitis
Osteoarthritis
Kidney Disease
Depression
Hypothyroidism
Cushing's Syndrome
Depression Or Anxiety
Sleep Apnea
Stroke
Gallstones
Hernia
Arthritis
Others
None
Are you depressed/stressed?
Yes
No
Have you taken any antibiotics in the last two years?
Yes
No
Have you taken any hormonal medications/steroids and anti-depressants in the last two years?
Yes
No
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