Join MicroChange You

You Are Not Just A Number On The Scale

Lets start the quiz to see which program is best for You

What is your first and last name?

Please enter your first name and last name.

What is your birthday?

Please enter your birthdate.

What is your email address?

Please enter valid email.

What was your sex assigned at birth?

Male Female Intersex Decline to answer Please select gender.

Which of the following programs have you tried to lose weight in the past?

Calorie counting / restricting Cutting out certain foods Using a “structured diet” plan like keto, paleo, whole 30, intermittent fasting, etc. Meal replacements Commercial weight management programs like Jenny Craig, Nurtrisystem, Weight Watchers, etc Other None Please select anyone

How long have you been trying to lose weight?

Less than 6 months 6 - 12 months Several years My whole life I’ve never tried to lose weight in the past Please select anyone.

What is motivating you to lose weight?

For myself Improve my overall health Fit better in my clothes Increase confidence Gain more energy For my family Other Please select anyone.

What is your height?

Please enter height feet and inches value.

What is your current weight?

Please enter weight.

What is your goal weight?

Please enter goal weight.

Has anyone in your family struggled with their weight?

Father Mother Sibling Grandparent Aunt / Uncle Cousin Child No one Please select anyone.

Have you ever been diagnosed with, or treated for, any of the following medical conditions?

Kidney problems (not including kidney stones) Heart conditions such as coronary artery disease, heart failure, arrhythmias Stroke Brain cancer Suicide attempts / ideation Seizures Anorexia or bulimia Liver problems (not including non - alcoholic fatty liver disease) None Please select anyone.

Do you take any of the following medications?

Opioids Methadone Chemotherapies Antipsychotics (such as clozapine, olanzapine) None Please select anyone.

Do any of the following apply to you?

Had or plan to have an organ transplant Have been diagnosed with problems absorbing food Have had pancreatitis Have had gallbladder problems and still have your gallbladder Taking warfarin or cyclosporine None Please select anyone.

Join MicroChange You

You Are Not Just A Number On The Scale

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