The Anti Yo-Yo Blueprint

The Anti Yo-Yo Blueprint

Pre-Call Assessment
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
List the top 3 obstacles preventing you from losing weight and keeping it off for good.
Rate your ability to practise restraint (tracking, portion control, etc.).

1

2

3

4

5

1 is Worst, 5 is Best
Rate your ability to engage in self-monitoring (daily weight check, etc.).

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2

3

4

5

1 is Worst, 5 is Best
Rate your ability to have a clear vision of Future You.

1

2

3

4

5

1 is Worst, 5 is Best
Rate the presence of social support (family, friends, etc.) in your life.

1

2

3

4

5

1 is Worst, 5 is Best
Rate your ability to focus on long-term goals.

1

2

3

4

5

1 is Worst, 5 is Best
Rate your ability to adhere to structure.

1

2

3

4

5

1 is Worst, 5 is Best
Rate your current dedication to regular exercise.

1

2

3

4

5

1 is Worst, 5 is Best
Appointment
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