(208) 406-1084 excelweightloss@gmail.com

Are Cravings and Emotional Eating an issue for you?

If you are struggling with cravings and emotional eating there is a reason why!

To discover “why” complete this questionnaire and we will follow up with an email about some of the reasons behind these issues.

First Name

Last Name

If you wish to be contacted by phone, please provide number.

Please provide if you wish to be contacted by Skype

List any diets or weight loss programs you have tried.

Has your weight caused any physical ailments such as diabetes, high cholesterol, high blood pressure, arthritis, heart disease? Does your weight prevent you from doing the physical activities of daily life or other leisure activities?

When do these cravings occur?

ADVERSE CHILDHOOD EXPERIENCES AND OBESITY. The Adverse Childhood Experiences (ACE) Study is one of the largest investigations ever conducted to assess associations between childhood maltreatment and later-life health and well-being. The Study findings suggest that certain experiences are major risk factors for the leading causes of illness and death, including obesity, as well as poor quality of life in the United States. Answering these questions is optional buy may give you some insight as to what childhood events and traumas may be contributing to weight issues in your adult life. The more questions you answer YES to, the more at risk you may be. When you are finished answering the questions add up your YES answers. This is your ACE score.

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