SuP!r Metabolism Program
Pre Assessment Form
SMP Pre assessment form
Why is it important for you to have SuP!r Metabolism
lose weight
get over a medical condition, if yes, pls specify the medical condition
others, pls specify
Medical Condition
Specify
What leads you to binge eating / emotional eating?
How long have you been having the challenge of binge eating / emotional eating
On a scale of 0 to 10, “0” being the lowest and “10” being the highest, where would you rate your binge eating habit
0
On a scale of 0 to 10, “0” being the lowest and “10” being the highest, where would you rate your energy level and productivity
0
On a scale of 0 to 10, “0” being the lowest and “10” being the highest, where would you rate your quality of sleep
0
On a scale of 0 to 10, “0” being the lowest and “10” being the highest, where would you rate your stress and anxiety levels
0
When some of the above issues are sorted, what will that enable you to do, that you are unable to do now?
If you could Launch a Legacy, what would it be?
If there were no challenges, or you could easily overcome all challenges, ideally, What is the kind of impact you want to create in this world?
Submit Form
>