Free Diet Trial Application Survey Question Title * 1. What do you want in relation to your weight and health? How much weight would you love to shift? About 1 stone More than 1 stone Less than 1 stone Other health goals (please specify) OK Question Title * 2. What would it mean to you to reach your dream weight? OK Question Title * 3. How motivated are you to do something about this right now? Highly motivated and ready to get started Highly motivated but struggling to believe it is possible Low motivation as feels too hard Other (please specify) OK Question Title * 4. What challenges/barriers do you experience when trying to lose weight that stays off? Emotional, non-hunger eating Food cravings Low energy Time poor Lose weight but it creeps back on Other (please specify) OK Question Title * 5. What weight loss programmes have you tried in the past and/ or are currently doing? OK Question Title * 6. Please use this space to tell your story and why you would like to participate in a free diet trial which includes group motivational coaching support, balanced nutrition, and meal plans for weight loss that stays off? OK Question Title * 7. Would you prefer 1 on 1 weight loss, motivation and balanced nutrition support rather than in a group setting? If yes, share your reasons why. OK Question Title * 8. In relation to your wellness and life balance what are your top three challenges? OK Question Title * 9. I am looking for 20 volunteers for a 4 week FREE diet trial. This is a Patrick Holford nutritionally balanced programme to increase energy, burn fat fast and turn your skinny gene on! The results will be used as part of a nation wide study on weight loss, energy and motivational coaching support. I have limited spaces for the diet trial and each applicant will also be offered a free place on a kick start workshop. All applicants will be contacted by email and phone as part of the application process and offers of places. Please provide your contact details. Name Address Address 2 City/Town State/Province ZIP/Postal Code Email Address Phone Number OK Question Title * 10. When is the best time to contact you? DAY between 12:00 and 14:00 EVENING between 18:00 and 20:00 Other (please specify) OK DONE