SuP!r Metabolism Program
Pre Assessment Form
SMP Pre assessment form
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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?
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