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Assessment Form

Please fill the following fields to know your fitness status.

Step 1: Body Mass Index (BMI)

The Body Mass Index calculation applies to both men and women and is used because of its direct correlation to being overweight.

	Your Email Address	*
	Gender:
	What is your height?	inches
	What is your current weight?	lbs
	What is your target weight?	lbs

Step 2: Optional Waist to Hip Ratio

For a more accurate assessment, insert the information below so we can calculate the ratio of your waist circumference to your hip circumference. This information is optional -- please feel free to skip this step.

Note : Your waist is the narrowest portion of your torso near your belly button, and your hips are the widest portion near your buttocks.

What is the measurement of your waist?	inches
What is the measurement of your hips?	inches

Step 3: Personal History

Environmental factors need to be taken into consideration when starting on a new weight-loss regimen.

What is your family and environment weight loss history?

	Most of my family and friends are overweight.
	Many of my family and friends are overweight
	Some of my family and friends are overweight.
	None of my family and friends is overweight.

How difficult is it for you to lose weight?

	Very Difficult - I have been dieting for over 6 months, and tend to gain and lose weight through yo-yo dieting.
	Somewhat Difficult - I have been dieting for more than 2 months, and have only seen slight improvement.
	Moderate - It takes effort for me to lose weight, but I can do it.
	Very Easy - It does not take much effort for me to lose weight

How difficult is it for you to follow a diet plan?

	Very Difficult - I have little will power, and have a tough time maintaining diets.
	Somewhat Difficult - I can stick to my diet about half the time.
	Moderate - It takes effort for me to stick with a diet, but I can do it.
	Very Easy - It does not take much effort for me to follow a rigorous diet.

How often do you exercise?

	I regularly do rigorous strength and cardiovascular workouts
	I often do cardiovascular activities such as running, aerobics, or cycling
	I regularly lift weights.
	I sometimes do light cardiovascular activities such as walking or jogging.
	I do not workout.