Assessment Intekai Free Weight Management AssessmentComplete the assessment to get the life you want.Please enable JavaScript in your browser to complete this form.Do you wish to lose weight, yes or no? *YesNoWhat is your goal weight? *Format: 215.5lbsWhat is your current weight? *Format: 215.5lbsHow tall are you? *Format 5 ft 3 inBMIHow old are you?Format: 25 yearsWhat is your gender? *FemaleMaleWhat is your full name? *FirstLastWhat is your Email address? *What is your primary telephone number?Which of the following best describes your eating habits?I eat when I get a chanceI eat late at nightI eat irregularly and exercise oftenI eat healthily and work outI have been trying to lose weight but can'tI eat once a dayAre you experiencing any of the following health conditions? *High Blood PressureDiabetesPolycystic Ovarian Syndrome (PCOS)Kidney DiseaseDepressionHeart diseaseDiverticulitisOtherNone of the aboveSubmit
