Weight Loss Registration

Personal Data

 
Wilmington, NC
Goldsboro, NC

Medical History

 
High Blood Pressure
Depression
Heart Disease
Lung Disease (eg: Asthma)
Diabetes
High cholesterol
Kidney Stones
Sleep Disorder
Glaucoma
Thyroid Disorder
Hormones or Birth control
 
 
 
Heart Disease
Stroke
Diabetes
Cancer
High Cholesterol
Obesity
 
 
 
 
 
 
 
Weakness
Dry, coarse skin
Tired
Swelling of face and eyelids
Coldness and cold skin
Diminished sweating
Coarse hair
Pale skin
Constipation
Gain in weight
Loss of hair
Labored, difficult breathing
Swollen feet
Hoarseness
Loss of appetite
Nervousness
Heart palpitation
Slow movement
Poor memory
Emotional instability
Depression
Headaches
 

 

*Individual results may vary.