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Visitor Survey - All about You and How I can Best Help you

The Real Weight Loss Tips website arose from my desire to create a resource for my existing customers and weight loss coaching team. To ensure it continues to serve the people who visit regularly, I really welcome your involvement to develop more information tailored to support you in the way you need it.

Please help to shape this site by taking a few minutes to let me know your priority needs for weight loss support, products and any frequently asked questions. First we need to get you subscribed, so you get lots of nice freebies as a member of Real Weight Loss Tips - it's free, so go ahead and put your name and email into the box below, then move to the survey form - thanks.

Tell us What you Need to Help with Losing Weight

Please note that all fields followed by an asterisk must be filled in.

How long ago were you last at a weight you were happy with?*
How long ago were you last at a weight you were happy with?*

	1 year or less
	1-2 years
	2-5 years
	5 years or more
	10 years or more

Why do you think you gained the extra weight?

	Eat too much
	Eat the wrong foods
	Eat at odd times
	Exercise too little
	Stress or lifestyle
	Comfort eating
	Binge eating
	Medical reasons

What have you tried before to lose weight (please list all prior programs)?

	Slimming clubs
	Online diets
	Calorie counting
	Exercise
	Starvation
	Restricted diet plan
	Diet pills
	Other

Why do you think it/they didn't work?

	Got hungry
	Got bored
	Didn't lose anything
	Lost too much energy
	Not enough willpower

On a scale of 1-10 with 10 being the most serious, how serious are you about losing weight and shaping up?

	1
	2
	3
	4
	5
	6
	7
	8
	9
	10

Why do you want to lose this weight now?

	health problems
	an upcoming beach vacation
	no special reason
	getting married or other big event
	doctor told you to lose it
	just think it would be a good idea
	other reasons not listed...

What would you like to see on Real Weight Loss Tips?*
What would you like to see on Real Weight Loss Tips?*

If I could show you a diet plan where you can eat the foods you love, you don't get hungry, gain loads of energy, get online support and don't have to attend club meetings, how much would that be worth to you each month?

	£0
	£50
	£100
	£250
	£500+

First Name*
First Name*

E-mail Address*
E-mail Address*

Street Address*
Street Address*

Country*
Country*

Please enter the word that you see below.

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