Have you gained 15 or more lbs in the past 5 years?

Have you been gaining weight even though you exercise and eat the same? 

Do you find it increasingly difficult to exercise? 

Do you suffer from energy loss? 

Do you feel that your memory has decreased? 

Do you have difficulty falling asleep or do you wake up in the middle of the night? 

Do you have cravings (sugar, carbohydrates, or salt)? 

Has your libido decreased? 

Do you find that you are often stressed out or tense? 

Has your bone mass or muscle mass decreased? 

Let us know what your particular symptoms are:

Would you like to be contacted for a free consultation to discuss your individual 
symptoms and potential solutions? 

If Yes, what is the best number to reach you?

If Yes, when is the best time of day to call you?

If Yes, what dates are best for a consultation?
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Weight Gain Survey
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