Are you ready for the Physicians' Choice Program?

This questionnaire is designed to assess whether you are ready to embark upon a comprehensive weight loss program. Certain times in a person's life are overwhelming and to add another program or condition to it is often more than one can handle. Sometimes our frame of mind and our attitude is such that it would not be conducive to start a weight loss program. For each question, click the circle next to the answer that best describes your attitude to the questions below. Answer all the questions and click the "Click Here To Continue" button at the bottom of the page.

1.When reflecting on previous attempts to lose weight, how motivated are you to lose weight this time?

Not at all motivated
Slightly motivated
Somewhat motivated
Quite motivated
Extremely motivated

2. During the process of weight loss, do you imagine eating a lot of your favorite foods?

Always
Frequently
Occasionally
Rarely
Never

3. Think truthfully about the total amount of weight you hope to lose and how quickly you hope to lose it. Calculating a weight loss of approximately one to two pounds per week, how realistic is your expectation?

Very unrealistic
Somewhat unrealistic
Moderately unrealistic
Somewhat realistic
Very realistic

4. Physicians' Choice for Weight Loss^sm requires daily recording of your food, with calorie, protein, fat, and fiber intakes. How certain are you that you will keep up with this daily food diary?

Not at all certain
Slightly certain
Somewhat certain
Quite certain
Extremely Certain

5. How positive are you that you can perform aerobic exercise 6-7 days per week for 30-40 minutes, and resistance training 2 times per week ?

Not at all positive
Slightly positive
Somewhat positive
Quite positive
Extremely positive

6. Consider the current level of stress in your life at this time (your job, school, your marriage, relationships, family obligations, etc.). To what extent can you manage the effort required to stick to a comprehensive weight loss program like Physicians' Choice?  

Cannot manage
Uncertain
Can manage
Can manage well
Can manage easily

7. This program will require daily exercise. Considering a place and the time it takes to exercise (both for aerobic and resistance training), are you sure that you will have a place to exercise and can work this into your schedule on a daily basis?  

Not at all sure
Slightly sure
Somewhat sure
Quite sure
Extremely sure

8. While on a weight loss program, do you feel cheated, perturbed, angry or upset?  

Always
Frequently
Occasionally
Rarely
Never

9. Physicians' Choice has designed comprehensive educational and motivational modules that you are required to participate in on a 2-3 times per week basis. Are you confident that you will be able to keep up with the demands involved in the learning/behavioral aspect of this program?

Not at all confident
Slightly confident
Somewhat confident
Quite confident
Extremely confident

10.How assured are you of your commitment to the Physicians' Choice  program for the duration that it will take to reach your goal (12 weeks or longer)?  

Not at all assured
Slightly assured
Somewhat assured
Quite assured
Extremely assured