2. Which food is hardest to resist?

🍩 Sweets & carbs
🍕 Big meals/fast food
🍷 Snacks & drinks
🥑 Healthy foods but too much

3. What’s your eating “personality”?

🍴 I love BIG portions
🕒 I skip meals then overeat later
😔 I eat my feelings
🎉 I eat more in social settings

4. How often do you find yourself eating without feeling physically hungry?

🤷 Often
😐 Sometimes
🙅 Rarely

5. What’s your biggest challenge with food?

🚫 Can’t stop once I start
⏰ Eating too late at night
🛑 Cravings hit me hard
😓 Stress or emotions drive me to eat

6. When you’re trying to lose weight, what usually gets in the way?

🍔 Eating out or social events
🏃 Lack of time/meal prep
🍬 Sweet or carb cravings
🔄 Falling back into old habits

7. How do you usually feel after eating?

😴 Tired or sluggish
😊 Satisfied and energized
😖 Guilty or regretful
🤔 Still hungry

8. Do you tend to eat quickly or slowly?

⏩ Very fast
⏱ Average pace
🐢 Slowly and mindfully

9. How often do you snack between meals?

🍿 All the time
🍎 Once or twice a day
🚫 Rarely or never

10. When you see tempting food (pizza, dessert, etc.), what usually happens?

🤤 I can’t resist
🤔 I sometimes give in
💪 I can usually say no

11. How do weekends affect your eating habits?

🎉 I overeat/socialize a lot
🔄 Pretty much the same as weekdays
🧘 I actually eat better on weekends

12. How often do you feel in control of your eating?

🙌 Almost never
😬 Sometimes
💯 Most of the time

13. What’s your go-to comfort food when you’re stressed or tired?

🍫 Chocolate/sweets
🍟 Fried/fast food
🍞 Bread/pasta
🥛 Ice cream/dairy
❌ I don’t usually stress-eat

14. How often do you eat out (restaurants, fast food, delivery)?

🍔 Almost every day
🍽 A few times per week
🏠 Mostly home-cooked meals

15. Do you tend to multitask while eating (TV, phone, work)?

📺 Always
📱 Sometimes
🧘 Rarely/never

16. How do you usually handle cravings?

😅 I give in right away
⏳ I try to wait it out but usually give in
🛑 I have strategies that help me stop
🙌 I rarely get strong cravings

17. Do you usually finish everything on your plate, even if you’re full?

✅ Always
🍽 Sometimes
❌ Rarely/never

18. What’s your current weight and height? (We will auto-calculate your BMI)

Weight: lbs

Height: ft in

19. Have you ever been told you qualify for bariatric surgery?

Yes
No

20. Have you tried other weight loss programs before?

Yes
No

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