Weight Assessment Form

Inclusion/Exclusion Criteria

Are you between the ages of 18 and 74?
Based on your age, you cannot be included in this program.
Do you suffer from prediabetes, diabetes, heart disease, high blood pressure, high cholesterol or obstructive sleep apnoea?

Weight

This assessment is crucial for your weight loss consultation. Please be honest with your answers and about your current medical conditions and medications as it helps our doctors prescribe effective medication and provide tailored advice. Make sure to read the medicinal information provided below before completing the assessment.

https://www.medicines.org.uk/emc/files/pil.15484.pdf

Unit of measurement *
cm
kg
ft
in
lbs

BMI

Your BMI is [8088]. Based on the data you have submitted, you cannot be included in this program.
Your BMI is [8088]. Based on the data you have submitted, you cannot be included in this program.
Underweight
Healthy
Overweight
Obese
This is a continuation of my ongoing weight management plan and there have been no changes to my medical condition.