Welcome back to Real Food Court. I am thrilled that you have decided to take steps to improve your health and wellness. Before our first session it will be helpful for me to get to know you a little bit better. Please complete the questionnaire below. Feel free to leave questions blank if you don't feel comfortable answering or the question is not applicable to you. 

Name *
Check the following medical conditions that you have been diagnosed with:
Describe how much weight was lost, over what period of time, and how much, if any, was gained back. Feel free to comment on what strategies worked best for you.
examples: cook at home, fast food, restaurant, workplace cafeteria, convenience foods, replacement shakes