WEIGHT LOSS HISTORY
Patient Name:
Date:
I have included my diet and weight loss history for a period of
years
past diet attempts
Supervised Diet Attempts:
Method Attempted
Start Date
End Date
Weight Loss
End Results
Diet Pills from MD
Diet Shots from MD
Supervised Calorie Counting Diet
Weight Watchers
Nutri Systems
Jenny Craig
Medical Weight Loss
Overeaters Anonymous
Diet Center
Optifast
HMR
TOPS
New Direction
Non Supervised Diet Attempts:
Method Attempted
Start Date
End Date
Weight Loss
End Results
Dr. Atkins
Gastric Bubble
Gloria Marshall
Grapefruit Diet
Health Spa
High Protein
Hypnosis
Jaw Wiring
Sugar Busters
Pritikin
Richard Simmons
Scarsdale
Stillman
Calorie Counting on my own
Slim Fast
Low Fat
Mayo Clinic