ideallyou! - ur ideal slimming survey

ideallyou! - ur ideal slimming survey

Have you been thinking if Acupuncture Slimming is suitable for you?

Why not take the short survey below to find out your answers..

*

*Have you ever tried to slim/trim down?

Yes

No

*

*Currently, you are..

Underweight	Just nice	Mildly overweight
Overweight	Obese

*

Medical History

*I have

Nil

High Blood Pressure

Diabetes

Tyroid

Asthma

Others. Please state below..

What methods of slimming have you tried before? (Please select)

Beauty / Slimming Centre

Doctor's Prescription

Dieting / Skipping Meals

Exercise (Outdoor, Gym, Yoga, Wellness Centre, etc)

Others, Please state below..

How much have you spent on the above methods?

(Eg. over $5000, $100 monthly)

*

*How effective were they?

(eg: bounced-back, maintained, feel sluggish, heartbeat fast, etc.)

Are you satisfied with your Body Shape / Contour?

Yes

No

If No, which area do you wish to improve on? (Pls select)

Hips

Waist, Tummy

Upper arms, Upper legs

Bustline, Cupsize (females only)

Others, Please state below..

* *Name:

* *Gender:

* *Contact No.:

* *Email:

* *Preferred time to call: