Questionnaire | Metabolic Health Solutions

1 Are you told that you sleep loudly?

1. Are you told that you sleep loudly?*

Never
Sometimes
Often
Always

2 Do you experience cravings for sweet foods?

2. Do you experience cravings for sweet foods?*

Never
Sometimes
Often
Always

3 Do you experience stomach bloating or indigestion?

3. Do you experience stomach bloating or indigestion?*

Never
Sometimes
Often
Always

4 Do you feel sleepy after eating a main meal?

4. Do you feel sleepy after eating a main meal?*

Never
Sometimes
Often
Always

5 Do you find it difficult to lose weight?

5. Do you find it difficult to lose weight?*

Never
Sometimes
Often
Always

6 Do you regain weight quickly?

6. Do you regain weight quickly?*

Never
Sometimes
Often
Always

7 Do you find it difficult to sleep soundly?

7. Do you find it difficult to sleep soundly?*

Never
Sometimes
Often
Always

8 Do you forget things easily?

8. Do you forget things easily?*

Never
Sometimes
Often
Always

9 Do you have cold hands or feet?

9. Do you have cold hands or feet?*

Never
Sometimes
Often
Always

10 Do you lack motivation to exercise on most days?

10. Do you lack motivation to exercise on most days?*

Never
Sometimes
Often
Always

11 Do you wake up in the morning feeling tired?

11. Do you wake up in the morning feeling tired?*

Never
Sometimes
Often
Always

12 Do you yawn after eating a main meal?

12. Do you yawn after eating a main meal?*

Never
Sometimes
Often
Always

13 Reason for completing questionnaire?

13. Reason for completing questionnaire?*

Weight Loss
Energy and Fatigue
Health and Wellness
Other

Please submit your questionnaire

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Last Name*

Contact Number

Email*

Preferred Clinic*

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Patients

Weight loss and metabolic health

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Weight loss and metabolic health

Can MHS Help You?

Please submit your questionnaire

Patients