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First up, what should we call you?
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How would you rate your current activity level?

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This is required to calculate your Health Risk Score.
Sedentary (little or no exercise)
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Lightly Active (light exercise/sports 1-3 days/week)
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Moderately Active (moderate exercise/sports 3-5 days/week)
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Very Active (hard exercise/sports 6-7 days per week)
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Extra Active (very hard exercise/sports & physical job or 2x training)
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Which of the following is your preferred snack option?
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Which of the following will be your preference for snack option?
A bowl of popcorn with a dash of olive oil, lemon juice, and sea salt!
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A big bag of kettle chips… I like salty snacks.
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Guacamole with onion, chiles, and cilantro, plus baked Tostitos.
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Candies in every color: Skittles, Starbursts, and Mini-Snickers… I want ‘em all!
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Please select anything that applies to you:
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%%FIRST%%, our programs are personalized to you. You will receive recommendations and guidance based on your medication conditions and health risk status.
Cardiovascular diseases, including heart disease and stroke
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Diabetes including pre-diabetes
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Sleep apnea - difficulty breathing while sleeping
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Asthma and/or chronic obstructive pulmonary disease
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Osteoarthritis and joint pains
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Fatty liver disease
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Anorexia / Bulemia
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Seizures
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PCOS
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High blood pressure
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High cholesterol
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None of the above
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How many cups of coffee or caffeinated drinks do you have per day?
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How much caffeine do you consume per day?
0 — I’m caffeine free.
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1-2 — I usually have a cup or two in the morning and one in the afternoon. 
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3 + — I’m a bit of a caffeine fiend. I can’t get much done without my coffee or tea.
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How are you with your fruit and vegetable consumption?
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How many servings of fruits and vegetables do you have per day?
0 servings: I do not like fruits or vegetables. They are just garnishing meat.
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1-2 servings: I eat fruits or vegetables as a snack or at least one meal.
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3-4 servings: I eat some fruits or vegetables with each meal and at least one snack
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How much alcohol do you consume per week?
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Please tell me your best estimated on alcohol consumption per week
0 drinks - I do not drink alcohol
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1-3 drinks — Alcohol isn’t really my thing. But if I’m celebrating, I might have a glass or two.
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4-7 drinks — I usually have a glass of wine or beer with dinner. While I drink regularly, I rarely get drunk.
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7+ drinks — I have a couple of drinks per day. Occasionally I party a little too hard and wake up with a hangover.
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How much water do you typically drink per day?
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How many glasses (8 oz) of water do you drink per day?
0 glass. I do not like the taste of water.
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1-2 glasses — Okay, I know I should be drinking more, but it’s so easy to forget!
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2-6 glasses — I’m pretty good with sipping water throughout the day. No dehydration headaches for me!
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6-8 glasses — I’m all about hydration… You couldn’t pay me to stop drinking my eight glasses.
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How well do you manage your stress level?
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Please rate how your stress level is managed usually?
I am unable to manage my stress
My stress is well managed
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Your Health Risk Status: GOOD HEALTH
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Based on your answers, you are in GOOD HEALTH. You need to continue with a health maintenance plan.  In order to maintain or improve your current health risk score, you need to maintain:
  • Adequate activity level, which includes physical activity guidance and resistance training
  • Maintain adequate calorie intake, which includes calories from fruits, vegetables, dairy, and leaner meats, and minimize saturated fat and sodium.
  • Get adequate sleep. Sleep is needed to recuperate the mind and physical body to prepare for the next day. 
At Valley Forge Weight Management Center (VFWMC), we emphasize all the above, plus building healthy habits. You do not have to be alone in this learning process. You can schedule an initial consultation visit to learn about all.  You can schedule both in-person and virtual visits.

After the visit, you will get a:
  • Personalized meal plan
  • Personalized physical activity recommendation
  • Detailed cardiovascular health risk score
  • Personalized recommendations for medical conditions screenings
  • Access to an online course on building healthy lifestyle skills (2.5 hours of video lectures plus resources - worth $99) - Free!
ALL VISITS AND GUIDANCE BY A BARIATRICIAN (Physician with specialized training in obesity management) only.

%%CATEGORY_TOTAL_PERCENT%%
%%CATEGORY_TOTAL_NUMBER%%
[CATEGORY_TOTAL_PERCENT]
[CATEGORY_TOTAL_NUMBER]
Your Health Risk Status: MILD HEALTH RISK
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Based on your health risk score, you are in MILD HEALTH RISK. Your weight category is Overweight.

You will benefit from our Low-Calorie Meal Replacement Program. This is a structured personalized program, which includes recommendations and guidance on:
  • Adequate activity level, which includes physical activity guidance and resistance training
  • Adequate calorie intake, which includes calories from fruits, vegetables, dairy, and leaner meats, and minimizes saturated fat and sodium.
  • Sleep recommendations. Sleep is needed to recuperate the mind and physical body to prepare for the next day. 
  • Meal replacements to meet macronutrient requirements and fat loss.
At Valley Forge Weight Management Center (VFWMC), we emphasize all the above, plus building healthy habits. You do not have to be alone in this learning process. You can schedule an initial consultation visit to learn about all.  You can schedule both in-person and virtual visits.

After the visit, you will get a:
  • Personalized meal plan
  • Personalized physical activity recommendation
  • Meal replacements recommendations
  • Detailed cardiovascular health risk score
  • Personalized recommendations for medical conditions screenings
  • Access to an online course on building healthy lifestyle skills (2.5 hours of video lectures plus resources - worth $99) - Free!
ALL VISITS AND GUIDANCE BY A BARIATRICIAN (Physician with specialized training in obesity management) only.

%%CATEGORY_TOTAL_PERCENT%%
%%CATEGORY_TOTAL_NUMBER%%
[CATEGORY_TOTAL_PERCENT]
[CATEGORY_TOTAL_NUMBER]
Your Health Risk Status: MODERATE HEALTH RISK
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Based on your health risk score, you are at a MODERATE HEALTH RISK. Your weight category is Obese.

You will benefit from our Personalized physician-supervised medical weight loss program. This is a structured personalized program, which includes recommendations and guidance on:
  • Adequate activity level, which includes physical activity guidance and resistance training
  • Adequate calorie intake, which includes calories from fruits, vegetables, dairy, and leaner meats, and minimizes saturated fat and sodium.
  • Monthly anti-obesity medication prescription to help you work with your body and not fight your willpower all the time. 
  • Sleep recommendations. Sleep is needed to recuperate the mind and physical body to prepare for the next day. 
  • Meal replacements to meet macronutrient requirements and fat loss.
At Valley Forge Weight Management Center (VFWMC), we emphasize all the above, plus building healthy habits. You do not have to be alone in this learning process. You can schedule an initial consultation visit to learn about all.  You can schedule both in-person and virtual visits. 

After the visit, you will get a:
  • Personalized meal plan
  • Personalized physical activity recommendation
  • Meal replacements recommendations
  • Detailed cardiovascular health risk score
  • Personalized recommendations for medical conditions screenings
  • Access to an online course on building healthy lifestyle skills (2.5 hours of video lectures plus resources - worth $99) - Free!
ALL VISITS AND GUIDANCE BY A BARIATRICIAN (Physician with specialized training in obesity management) only.

%%CATEGORY_TOTAL_PERCENT%%
%%CATEGORY_TOTAL_NUMBER%%
[CATEGORY_TOTAL_PERCENT]
[CATEGORY_TOTAL_NUMBER]
Your Health Risk Status: SEVERE HEALTH RISK
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Based on your health risk score, you are at a SEVERE HEALTH RISK. Your weight category is Morbidly Obese.

You will benefit from our Personalized physician-supervised medical weight loss program. This is a structured personalized program, which includes recommendations and guidance on:
  • Adequate activity level, which includes physical activity guidance and resistance training
  • Adequate calorie intake, which includes calories from fruits, vegetables, dairy, and leaner meats, and minimizes saturated fat and sodium.
  • Monthly anti-obesity medication prescription to help you work with your body and not fight your willpower all the time. 
  • Sleep recommendations. Sleep is needed to recuperate the mind and physical body to prepare for the next day. 
  • Meal replacements to meet macronutrient requirements and fat loss.
At Valley Forge Weight Management Center (VFWMC), we emphasize all the above, plus building healthy habits. You do not have to be alone in this learning process. You can schedule an initial consultation visit to learn about all.  You can schedule both in-person and virtual visits. 

After the visit, you will get a:
  • Personalized meal plan
  • Personalized physical activity recommendation
  • Meal replacements recommendations
  • Detailed cardiovascular health risk score
  • Personalized recommendations for medical conditions screenings
  • Access to an online course on building healthy lifestyle skills (2.5 hours of video lectures plus resources - worth $99) - Free!
ALL VISITS AND GUIDANCE BY A BARIATRICIAN (Physician with specialized training in obesity management) only.

%%CATEGORY_TOTAL_PERCENT%%
%%CATEGORY_TOTAL_NUMBER%%
[CATEGORY_TOTAL_PERCENT]
[CATEGORY_TOTAL_NUMBER]
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