EDMONTON CLINICAL HYPNOTHERAPY, EXECUTIVE COACHING & ACCELERATED SUBCONSCIOUS RESTRUCTURING

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Educational Series

Terri Lee Cooper MSc. RSW NLP_M DCH  

St. Albert Medical Centre

Weight-Personal Assessment

Please note that all fields followed by an asterisk must be filled in.
I am tired of not being able to wear clothes I like
I think about food quite often
I remember a time when my body felt lighter
I am seeing my poor food habits in my children
I avoid social activities because of my weight
I have thought about gastric surgery
I believe some people prefer me fat
I frequent fast food drive thu’s
I miss feeling attractive
I feel obsessive about food
I do not exercise regularly
I am embarrassed about what is seen in my shopping cart
I see that my children are becoming overweight
I lie to my spouse about how much food I eat
I feel food has too much power over me
I have used laxatives to lose weight
I am sneaky about my eating
I worry about heart disease and diabetes
I lose weight and gain it all back
I compare my weight loss to others’
I just feel fat and sluggish
I feel trigged to eat by certain situations
I never thought I would be this overweight
I have used diet pills
I am embarrassed about my weight
I think my partner resents my weight
I have a sense of the me who is healthier, more flexible and slimmer
I know I deserve a healthy body
I eat mindlessly in front of the tv
I am depressed by my weight
I have almost lost faith about my ability to lose weight
I weigh myself quite often
I have tried a variety of weight loss programs
I sometimes am embarrassed or ashamed about my junk food eating
I have tried conventional programs for weight loss
I use food to manage my emotions
I need help creating a healthier mindset
I worry that my children will pick this problem up from me
Immediately
Within 2 weeks
One month+
Yes
No

Please enter the word that you see below.

  

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