How did you find out about us?
How did you find out about us?
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Referred by a friend
Google search
Facebook
Instagram
Signage
Previous member
Doctor Referral
Another way?
* Please select at least one response before proceeding
Age range
Age Range
20s
30s
40s
50s
60s
70+
* Please respond to proceed
Tick any health concerns:
Tick any that are a concern for you.
Bloating or gut health
Blood sugar, diabetes or pre-diabetes
Feeling depressed, anxious or mood swings
Headaches, migraines or brain fog
Heart disease, stroke or high blood pressure
Muscle or joint pain
Physical activities are difficult
Any other concerns?
If you have any health condition always seek the advice of your doctor.
Your health goals
What are your health goals?
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Being at my best weight
Happiness & confidence
Having loads of energy
Feeling fit & healthy
No more aches & pains
No more food cravings
Good quality sleep
Any other health goals?
* Please select at least one of the above to proceed.
Do you have a goal weight in mind?
What is your current weight?
*
What is your goal weight?
*
* Please give an answer to proceed.
When were you last at your goal weight?
When were you last at your goal weight?
In the past 12 months
In the past 24 months
More than 24 months
When would you like to be at your goal weight?
Month and Year
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Is this for a special occasion?
Holiday
Birthday
Anniversary
Wedding
Another occasion?
* Please provide an answer to proceed
Which part of your body do you mainly store your weight?
Which part of your body do you mainly store your weight?
Upper body - chest, arms, shoulders and upper back
Mid-section - tummy, waist
Lower body - hips, buttocks and thighs
What things stop you from being at your ideal weight?
What do you think are the main causes of your current weight? Tick any that apply.
My metabolism has changed
My eating & drinking habits
My lack of physical activity or motivation
Injury, medical condition or medication
I've always struggled with my weight
Influence from friends, family or workmates
Poor quality sleep
Any other reasons?
Have you tried any of these to lose weight?
Previous Weight Loss Methods
Weight Watchers
Jenny Craig
Lite 'n Easy
Online or App-based program
Gym membership or exercise
Self dieting
Meal replacement shakes
Appetite suppressing drug
Bariatric surgery
Anything else you've tried?
How long did you continue with your efforts?
Not long
For a while
A long time
Did you see any improvement for the effort and time you spent?
None at all
Small improvement
Great improvement
Do you have any dietary restrictions or food allergies?
Yes
No
* Please select one to proceed
We've helped over 11,000 people lose over 100,000 kilos so far with private weekly, one-on-one coaching via Zoom, phone or in-centre.
Quiz Summary & Invitation
Would you like us to email you your quiz summary and show you how the Dietflex program can give you the results you're after?
Yes
No
* Please select one to proceed
First Name
*
Email
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Phone
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Suburb or town
