How often do you take fast foods and other high fat foods?
Once a monthOnce a week2-3 times a weekOnce a day or more

How much plain water do you drink a day?
1-3 glass4-6 glass7-9 glass9 glass & above

Do you take snack/supper?
YesNo

If yes, pick the below: (check all that apply)
Potato chips/crackersNuts & fruitsFried snacksInstant/processed foodDessert (milk tea/cake/ice cream/cookies/chocolate)

Do you drink coffee or tea?
YesNo

How often do you drink coffee or tea?
Once a monthOnce a week2-3 times a weekOnce a day or more

On average, how long are you sitting everyday?
< 3 hours3-6 hours6-9 hours> 9 hours

How would you describe your current lifestyle?
Very activeActiveLow activeSedentary

How many times do you exercise per week?
< 3 times3-5 times> 5 times

How long do you usually exercise?
< 20 minutes20-45 minutes> 45 minutes

Select any exercise that you do usually. (check all that apply)
WalkRunSwimAerobics/CardioSportsNo! Never liked it! Never do!

How many hours of sleep do you get each night?
< 6 hours6-7 hours7-9 hours> 9 hours

Rate your current level of stress from 1 to 5 (1-not stressed, 5-very stressed)
1 - Not stress2 - Less stress3 - Moderate4 - Stress5 - Very stress

At this time of our life, how important is it to lose weight and keep it off? Rate 1 to 5 (1-not important, 5-very important)
1 - Not important2 - Less important3 - Normal4 - Important5 - Very important

Mind telling us your primary motivators to lose weight?
Improved healthFeel more attractivePlease others (family, friends, spouse)Have more confidenceFit into my favorite clothesEase joint painOther (please specify)

Have you tried any programme or supplement for weight loss in the past few months?
YesNo

How long have you been struggling with your weight?
Recent weight gainLifetime struggle

What are the biggest obstacles you face to losing weight?
Not sure how to doScare failingLack of time to careFeel expensive for fresh and healthy foodCan't avoid/ resist eating unhealthy foodlack of motivation

In the next 6 to 8 weeks, I would like to lose
0-2 kg2-4 kg4-6 kg6-8kg

Alternatively, tell us your desired weight to achieve

In what time frame would you like to be at your desired weight?
< 1 month1-3 month< 6 month

How much would it cost for an evidence-based supplement that you were convinced to attain your ideal weight? (per month)
RM100 or below≤ RM200≤ RM300No specific amount as long as it works

Are you ready to take up the Yes Challenge
YesNo