7 Days - New Body, New Life

WEIGHT LOSS RESISTANCE is a progressive chronic condition and its severity may be determined by categorizing the individual condition into one of five caegorizations.  The following quiz will help to assess which level you may have reached and what the best form of intervention might be.  Please answer all questions honestly.

This is NOT an automated quiz.  Every submission will be reviewed, using specific evaluation parameters, by Phil Kaplan or an affiliated member of his staff.  You'll recieve a result within 48 hours (2 business days).

  • First Name *
  • Last Name *
  • email *
  • Age *
  • Gender *
    Male
    Female
  • How many pounds do you weigh today? *
  • How many pounds did you weigh before you noticed you started gaining weight? *
  • How old were you at that time (when you first started noticing weight gain)? *
  • How many pounds do you want to lose (to feel as if you're at your best)? *
  • What is the "PRIMARY" Reason for your desire to lose weight? *
  • How long have you been overweight? *
  • In which of these areas did you gain weight? *
    Thighs
    Abdomen
    Upper Arms
    Hips (Buttocks)
    Check as many as apply
  • Approximately how many pounds did you gain in the last 18 months (if weight was lost put zero) *
  • Check ALL that have been impacted by your bodyweight: *
    Relationships
    Energy
    Self-esteem
    Health
    Performance
    Sex drive
    Career
  • Do you feel there is a primary stress or stressor connected to your weight gain? *
    Yes
    No
  • If you answered YES for the previous question, describe the stress (this is optional but useful)
  • Do you have "Brain Fog?" *
  • How is your Energy? *
  • Have you been diagnosed with a thyroid and/or adrenal condition? *
    Yes
    No
  • Have you been diagnosed with a diabetic condition or blood sugar irregularity? *
    Yes
    No
  • ADDITIONAL INFORMATION (Optional but Requested)
    If you'd like you may submit your responses and you'll receive an assessment based on the information you provided. The following questions require a bit more discussion and will provide far greater insight. Although it is not mandatory, you are encouraged to complete the following fields before submitting the form
  • Provide Further Information on any diagnosed conditions and/or medications you are taking now
  • Describe any attempts at weight loss over the past 18 months and share the long term outcomes
  • What health practitioners do you employ to help you lose weight and how did they help / disappoint?
  • How would you summarize the consensus of the professional advice you've received?
  • What do you believe is the best plan, program, or course of action for YOU?
  • Add any additional thoughts or comments and then submit the completed form.