Select all the weight management symptoms that apply to you
Fluctuating weight
Food cravings
Water retention
Binge eating or drinking
Purging
Other
Please Specify:
Feeling any of the following? Check all that apply
Fatigue (sluggish, tired)
Daytime Sleepiness
Insomnia at night
Restless (can't sit still)
Other
Please Specify:
How many hours of sleep do you get each night?
Less than a few zzz's (<4 hours)
4-6 hours
7-9 hours
9-11 hours
1/2 the day or more (12+ hours)
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