Why Do I really want to lose weight?
This form has been developed over the years in collaboration with our clients. They are real and valid reasons. If none apply to you there is space below for you to write anything that is pertinent to you.

Keep a copy of this for yourself as it will form part of some of the work in future sessions.

This form is what is going to help keep you on track and provide some real purpose moving forward.

Tick as many boxes as you like. This information is kept private,
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Email *
First Name *
Surname *
It's important for me to lose weight because:
Yes
I want to improve my self esteem
I'm Pre-Diabetic
I am Diabetic
I have high blood pressure
I've been told I have a fatty liver
I want to improve my sex life
I want to look better for my partner
I have surgery planned, I need to lose weight
I want to improve my mobility
If i lose weight my knees wont hurt as much
I have irritable bowel syndrome
I struggle to tie up my shoe laces
I have back pain, weight loss might help
I am trying to fall pregnant
My weight is affecting my job
My weight is affecting my relationship
My weight contributes to my depression & anxiety
I want more energy
I want to live longer
I don't want to die early
I want to slow down the ageing process
I don't like the way I sweat a lot
I am embarrassed when I go to the beach
I don't like the chaffing between my legs
I have sleep apnoea, weightloss will help
I don't like the way I wobble when I move
I hate being called "The Big Fella", "Big Man"
I am tired of lying to myself
I am 20Kg heavier than I was 10 years ago
I have mood swings for no reason
Add any other motivating reasons to lose weight that mean something to you!
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Phone Number *
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