1. Do you feel hungry or shaky 2-3 hours after a meal?
*
Yes
No
2. Do you experience frequent food cravings for sugary or starchy foods?
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Yes
No
3. If you miss a meal do you tend to feel angry or tired ?
*
Yes
No
4. Do you tend to retain water after a salty meal?
*
Yes
No
5. Do you get tired a few hours after eating?
*
Yes
No
6. Do you have high blood pressure?
*
Yes
No
7. Do you take medication to lower cholesterol?
*
Yes
No
8. Do you tend to gain weight quickly?
*
Yes
No
9. Is most of your excess weight carried around your abdomen?
*
Yes
No
10. Does anyone in your immediate family have diabetes or hypoglycemia?
*
Yes
No
11. Has anyone in your family had heart disease, polycystic ovarian syndrome or gout?
*
Yes
No
12. Do you suffer from mood swings?
*
Yes
No
13. Are you excessively tired in the afternoon or early evening?
*
Yes
No
14. Do you find it difficult to lose weight on a low fat diet?
*
Yes
No
15. Do you have increased thirst and/or frequent urination?
*
Yes
No
Full Name
*
Email
*