Consultation Questionnaire

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Full Name

Age

Date of Birth

Height

Weight

Occupation

Home Address

City, State, Zip

Email Address

Home Phone

Cell Phone

Are you: MarriedSingleDivorcedWidowed

How did you hear of us?

Date last physical

At what age did your weight problem begin?

Past or present medical conditions requiring treatment

Medication(s) presently using, including dosage and frequency

List the name and specialty of each of your physicians (one per line).

Past or present food, fruit or beverage allergies

Is there a special reason why you want to lose weight right now? Please explain.

How have you tried to lose weight in the past? What were the results?

How does being overweight affect your life?

Please give three reasons, in order of importance, why you want to lose weight.

If you are under 18 and living at home, your parents names

Mom's Cell Phone

Dad's Cell Phone

It's been a pleasure working with Rosalie. In the past, I've always lost weight but had great difficult keeping it off. This program has shown me that it's possible. I look forward to continuing towards my ultimate weight goal and keeping it off.

Great program! Eat to lose weight. I was amazed at how easy it was.

Weight No More has really helped me in many ways ... not only did I lose weight, but I now have a new approach on how to eat. The staff in Brooklyn is terrific, constantly helpful.

When I first came to Lori I had already tried different diets. All those other diets were really hard and had no room for any indulgences. I was getting so frustrated refraining from all types of food such as carbs and yogurt. With all my restraint and hard work I was not even losing any weight.I worked with Lori over the summer while in NJ, and she taught me how to eat without cutting out any of the food groups. She helped me reach my goal in no time! When summer was over, and I returned home to Brooklyn, we continued working over the phone on Stabilization and Maintenance, which was as effective as in person!Weight No More Diet Center became my life style. Lori has taught me had to plan to succeed and there's always room for the pleasures in life. This is not a diet; it's a lifestyle. It makes "dieting" easy.I love Lori and the program, and I would recommend anyone to work with her! It doesn't need to be in person. Just call her and within five minutes you'll see that you can reach your goals with just a few phone calls a week.

Everyone at the Cedarhurst location was so helpful in getting me started and keeping me on track. It’s been great to lose weight and not be hungry. This is my new lifestyle. Thank you Weight No More Diet Center!

After 30 years of being overweight, a visit with Rosalie changed that. So far I’m 40 lbs. thinner and still losing. Thanks for changing my life!!

After struggling with my weight for years and trying every diet under the sun, I have FINALLY found the one I can live with. I have never, from day one, felt deprived, hungry or anything but fantastic. The staff is excellent, helpful and understanding. I am thrilled with the program and know I can live the program always. Thanks SO much.

I would like to express my appreciation to Weight No More℠ diet Center for helping me lose over 100 pounds. The program is a very healthy mix of all the food groups, and I lost the weight without ever feeling hungry.Regina in the Brooklyn office was very helpful and professional in supporting me all along the way. I recommend Weight No More℠ to all my overweight friends.

In July I got on the scale and couldn’t believe what I saw. I realized I was exactly what the kids said I was. At that point I decided to lose weight. Now it is October, and I have lost 24 pounds. I feel great! The girls that used to call me fat now say, "Look how skinny he is." Last year I ran a mile in 10 minutes and 45 seconds and almost passed out. Now I run it in 8 minutes and 45 seconds, no problem. I have started eating veggies and they actually taste good. I feel much better about myself. I am able to do more, and I have realized if you set your mind to it anything is possible. Thank you Marcie and Lori for all your help and support.

I started at Weight No More October, 2016, and continued through April, 2017. While I didn't have a tremendous amount of weight to lose, it was enough to have been a problem for me to do on my own. The education and support I received from Lori was invaluable, and helped me reach my goal. It was a slow loss process, but most worthwhile. I will always be grateful for the guidance and expertise I received.

Being at Weight No More℠ Diet Center has been one of the best experiences of my life. I’ve lost weight before, but I never learned how to eat properly. Now I know how to plan every meal properly and healthy. My cholesterol, which has been high my whole life, has finally gone down. My whole life has changed, and I use what I’ve learned for my family too.

As I was walking down 42nd Street in Manhattan, eating a gigantic NYC pretzel, with my thighs chafing from rubbing together, I called Lori Boxer. She told me to get my rear end in ASAP, and the love and care I have received ever since from her staff is impeccable. This program is real -- real food, real change, working with real people. It’s my life forever.

The program helped me lose 55 pounds. I feel great, and it wasn't even that hard to accomplish my goal. It taught me a new way of eating correctly, and I don't feel hungry or over-full.

Linda, Rosalie and Rana have been very encouraging and motivating. It’s been gratifying to lose the weight so easily and feeling good is my greatest reward.

At 47 years old I thought it was okay to be 25 pounds heavier than I was at 27, that I couldn’t be as slim as I was on my wedding day. I had 2 children, and I thought my skinny days were over.A friend, after having her second baby, was seeing Lori Boxer and she looked amazing. She was eating real food and never hungry. I decided to meet with Lori to hear about the program and ended up joining that day.Lori was available to me 24/7. We met three times a week, which kept me going. She encouraged me, and I was proud of myself. I was given many food options and guided on how to pace my meals and snacks throughout the day. I was to never be hungry or skip food. Lori would review my weekly menu planning and give me advice. It was an education on eating right.Not only did I have more energy, I had new clothes! My husband can’t stop complimenting me. I’m the skinny girl he married.

My whole life I never struggled with weight. I got married at a size 2 and got pregnant right away. That’s when the pounds came on and never came off. After I had my daughter I struggled for 5 years to lose my "baby weight" but nothing worked for me. I wanted to lose my weight so badly but I had no motivation; until I found out about Weight No More℠ Diet Center. I lost 20 pounds in 13 weeks. They care about getting you slim and will be there with you every step of the way. Now I have the tools to eat right and live a healthy lifestyle. Thank You!

Lori's program is amazing. Those are not just words; it's a fact. I lost about 30 pounds after giving birth to my son and not a day went by that I complained of being hungry. I was always eating, just eating better. I will always be thankful to Lori for the time and effort that she put into my success. Three times a week I would go for a weigh in and a much needed "nudge" in the right direction, and that is what always kept me focused and on track, and it is her voice and diet plan I have in my head before the start of each week's meal planning. I am forever grateful!

Thank God for Weight No More Diet Center. I have been losing weight slowly and my blood pressure is so much better. I have other medical problems as well, and sometimes get discouraged, but even then I continue to come to the office because Rosalie, Rana and the other ladies are great. They always call and check on me and all the encouragement helps. I always feel better after seeing them.

Most of you have heard of the "Soup Nazi" from Seinfeld? Well, welcome to the "Diet Nazi" at Weight No More℠! The difference being, Lori cares!! After trying every diet known to man (Weight Watchers, NutriSystem, Jenny Craig, South Beach, Atkins, etc, etc.) Lori finally taught me the secret to eating properly for both weight loss and health! And her secret weapon: She is available to her clients 24 HOURS A DAY 7 DAYS A WEEK!!

I have been on the Weight No More Diet Center program for the past 9 months. I think it is a fabulous program, which incorporates eating your own healthy foods---no packaged or processed foods like other weight loss programs offer. I have lost weight consistently over this time, and they are now helping me to maintain my weight. I would recommend this program to anyone who is looking to lose weight safely.

The Weight*No*More Diet Center program is like no other out there. Unbelievably, you lose weight by eating normal food. Lori, Marcie, and Simi teach you sound nutritional principles, help motivate you, and create a high level of accountability, all of which leads to consistent, healthy weight loss. My primary goal in going to Weight*No*More was to lose weight. I did; however, the wonderful by-product of reeducating myself on how to eat will give me the lifelong skills needed to keep it off. This program is unique.

I find the program to be the most comfortable and easy way to transform healthy eating habits, not to mention the wonderful staff that show true concern for your health and all around accomplishment. The techniques of one-on-one commuication is the key to success. I would (and do!) recommend this "weigh of life" program anytime. Thank you for helping me find a way to a healthier and successful program to finally end my lifelong struggle.

I have been very happy with my contact with Rosalie in the Woodmere office. She has been very positive with every step of my progress, and that makes me want to continue on. I have been recommending her to other people, and I feel that there will be many more calls coming her way.

Here's the link to a wonderful testimonial from a former client who published it on LinkedIn:The SECRET to stop paying the "Fat Tax" in 2016 and actually LOSE WEIGHT

I think I'm your biggest source of referrals because I truly believe that you have the most amazing program.1 - It is personal, tailored to each one's need;2 - It is natural: no bars, no juices, no frozen foods, etc., because once you get off of those kinds of things you gain double what you lose.Rosalie is very accommodating, knowledgeable, fun, inspirational, helpful and, of course, very pleasant and nice.I score you 10 out of 10.

This is a really great progam! I am only 13 and really love it and find it helpful to my daily life. I LOVE the staff. They are very supportive and encourage me. I love this program and hope you do too.

Rosalie has really changed my life.Before I started with Weight★No★More℠ Diet Center I was having several health issues, including acid reflux, shortness or breath, etc. In just a few short months, I reached my goal and lost 30 pounds!With Rosalie's encouragement and guidance I have kept off the weight for six months now, and I am feeling great.Thank you so much, Rosalie, and Weight★No★More℠.

I had heard only good things about the program, and since I've started I have lost 13 pounds. I love how patient Rosalie is, and I feel motivated and powerful and happy every time I come into the office. Thank you for helping me get my life back.

The individual attention to your weight loss and diet is amazing. Rosalie and the staff know how to tweak your program to make it work. This is the most I’ve lost on any plan. I am not hungry and learning to eat right even through special occasions and holidays. Rosalie is a great cheerleader.

I never thought I could diet or change my eating habits. When I started with Weight No More℠ Diet Center I was skeptical as to whether or not I could actually do it. With the great care of Rosalie and Linda I was able to accomplish the unspeakable: Within a short time I lost a significant amount of weight while still being able to eat the foods I love.

I came to Weight No More Diet Center in July, 2011, with over 100 pounds to lose. So far (February 2012) I have lost nearly 60 of those pounds with this well-balanced, easy to follow for life food program. No gimmicks, no points to count or food to buy---just wonderful dietary choices. As important as the food program is the one-on-one weekly weigh-ins; Lori and Lisa provide outstanding support and motivation that helps me stay focused, especially when I fall off the horse! They are what make this program work over other weight loss programs where it’s easy to get "lost in the shuffle." With Lori’s and Lisa’s pep talks and suggestions, I know I will reach and maintain my goal!

Weight★No★More℠ gave me my life back!

I have been dieting unsuccessfully all through my teen and early adult years. I would starve myself all day, thinking that was the only way to drop the pounds. Since joining Weight★No★More℠, I have lost 70 lbs and have only 20 more to go. I exercise daily and have learned to eat three balanced meals a day with three snacks in between. I can say, since joining, I have never felt hungry or deprived at all. I look forward to eating since I know the food is fueling my body.I have Rosalie, in the Long Island office, to thank for all her words of wisdom, patience and positive attitude.If you are looking to lose weight, try this program. You won't be sorry.

I am so happy with the Weight No More℠ program! Finally, I am losing weight, seeing amazing results. Their program is the real thing--teaching me to eat more cleanly and healthier. This is a long-term way of eating. Totally doable and I can see myself continuing to eat this way for life, especially when it works and I can see the results!

This program is life changing. I have tried several programs over the years, and this is the ONLY one that gets it right. I came here to find a healthier way of eating while losing some weight, and that is exactly what I got. There is truly nothing else out there like this program and well worth the money. Lori is excellent at helping you stay focused and her wisdom is priceless.

My 13 year old son has lost 26 pounds so far and has gained even more in confidence in nearly two months with the program. He has found the process both easy and convenient and, for the first time ever, looks forward to his weigh-ins!We highly recommend Weight No MoreSM to everyone. Not only did he lose the weight he wanted, but he also learned life lessons in how to eat: correct portion sizes and how to read labels. These are priceless lessons that will help him stay successful throughout his life. Thanks so much.

I have tried every single diet and 'magic' weight loss program out there, and nothing worked for me until I went to Weight No More^SM. Rosalie has not only helped me lose 23 pounds thus far, but she has been my support and mentor throughout the entire process. She has taught me how to live and have a healthy relationship with food. Before her, I was a mess, and now I am happier than ever.

Rosalie makes losing weight as uncomplicated as possible. The program is easy to follow with lots of food options, and the tri-weekly weigh-ins keep me on track. I feel so proud of my weight loss.

"Nothing tastes as good as thin feels!" This is so true! This is the first diet program that truly works for me. I have tried many over the years and always gained the weight back. Lori has shown me how to eat from all food groups and still lose weight. I have discontinued anti-reflux and asthma medication with the approval of my physicians!Thank you, Lori, for your guidance and patience throughout this process.

I have tried every diet on the planet. Weight No More teaches you how to eat the right way. You learn the value of food. I have never felt better. I am in control and loving it!Lori knows her stuff! She can be tough but knows what she is doing. She gives personalized advice and menu suggestions when you are traveling and eating at restaurants. This was very beneficial to me when I traveled. She is always available for questions.This has been a game changer for me: Weight No More and Lori Boxer have changed my life!

I am so grateful to Weight No More Diet Center and its wonderful staff. After many years of trying to lose weight, this is by far the best year for me. I have learned so much and have a new healthy life due to my eating changes. I’m pleased with my progress so far, losing 39 pounds since June, and look forward to reaching my goal. I could not have done this without them. I have more energy, I look and feel younger, and I now have a figure to be proud of!

First, I’d like to express my gratitude and appreciation for Regina for her guidance, patience and assistance these last several months. I can thankfully say that with her support it has been a pleasure throughout. There were some ups and downs, and a few plateaus too, but Regina’s constant support and encouragement made me feel calmer and kept me going, and that gave me the push to do more. I felt like as long as I was doing the right thing and sticking to the program, I was heading in the right direction. And, after all these months of weighing and measuring and filling out those diaries, I can definitely say, “Nothing tastes as good as being SLIM feels!”

Weight No More Diet Center is a very good program that helped me lose weight with no struggle. I never feel hungry or deprived. The staff is always available if needed. Eating has never paid off so much!

Weight No More^SM Diet Center has been a great inspiration for me. I tried losing weight on my own for about two years and just didn't accomplish anything. Regina is wonderful. She is patient, but firm. I lost about 20 pounds, which I never thought I could, and I hope to lose more. Regina taught me a great deal about diet and has really helped me.

I have never had so much healthy food and successfully lost weight in such a short time. The 3X weekly counseling is so helpful and caring. They encourage their clients with their positive and upbeat manner. I appreciate how they’ve changed my life.

The program is very manageable, and I got used to writing in the journal. Love the pampering aspect when coming 3X a week. Makes the weight loss easier. They give you great recipes. The counselors are very warm women.

Beats Weight Watchers for me!!

After trying Weight Watchers a few times I found Weight No More℠ Diet Center to be much more effective. The program, plus the one-on-one meetings, hits the spot for me. No hunger pangs, no feeling cheated, and steady weight loss. There's nothing like having Rosalie help me plan my meals in no time flat, and giving me good hints to speed the weight loss. Wonderful diet! Thanks so much!

I’ve had a weight problem my entire life until now. Finally, a diet that works and the pounds are melting away without a plateau!! I’ve been on Weight Watchers; Nutrisystem; liquid diets and diet pills before starting this diet. The Weight No More Diet Center program provides me with individualized counseling and a nutritious, balanced food plan which will be a permanent life style in controlling my weight. I’ve learned to control food portions; to plan my meals and to drink plenty of water (I would never drink water previously)! Lori Boxer and the other counselors are available to help you achieve your weight goal and Lori makes herself accessible “24-7” via cell phone, website, and diet tips. I am excited about my weight loss (35 lbs) in only three months! My energy level has increased and I am not embarrassed to look at pictures of myself! My only regret was that I did not walk into Weight No More Diet Center sooner—I waited too long!! Thank you, Lori and staff!

I love this program! I am so close to my goal that I’m counting down the weeks until I’m at my magic number. I never felt this good or looked this good in my entire life. Everyone stops me to find out what I’m doing. I can go to any clothing store and pick out whatever I want, and everything looks good, as opposed to the past when I would go to the clothing store and leave not only empty-handed, but severely depressed. I can’t thank you guys enough.

I started at Weight No More Diet Center after I was diagnosed as pre-diabetic. My doctor told me that if I lost 25 lbs my A1C (3 month average glucose level) would come down and I would avoid having to start on medication.

I had tried several other weight loss programs, and nothing seemed to work. I am middle aged, which makes it more difficult to lose than when I was younger. I would lose 10 or 15 lbs and gain it right back. I was extremely frustrated until a friend of mine recommended Lori and her weight loss program.

Lori was the only person who explained what it meant to be pre-diabetic and insulin resistant . She explained that I had to start “linking” foods and to eat every few hours to keep my metabolism working properly. No one, including a nutritionist, had ever explained that to me.

Ultimately I lost 26 lbs., and my A1C is normal! I have reached my goal weight, and I now follow the program every day to maintain my weight loss and to stay healthy.

Thank you Lori for all your help in getting me healthier!

My experience with Lori and her Weight No More℠ Diet Center has been rewarding both in reaching my goal weight and benefiting from Lori's coaching and insightfulness. Her personal guidance and attention was my segway to losing an excess of 25 pounds. I truly feel healthier and more energetic as a result of my new eating habits. I could not have done this on my own. Thank you.

The program has really worked for me. In addition to losing weight and feeling better, I now take the time to think about my food, and enjoy my meals even more.

Weight No More Diet Center is a fabulous program. It works! I thought I could lose weight on my own and tried for months to do just that. I kept gaining weight as I wasn’t as educated as I thought I was. In tears, I turned to Weight No More and asked, "Are you sure you can help me?" I was assured they could, and thus I began a very successful program. The counselors are wonderful and knowledgeable, am so happy that I joined. I BELIEVE IN THEM IMMENSELY!

The program gives all healthy food choices that are easily accessible. The staff is extremely supportive and gives very individualized attention.

The program is amazing! The staff understands me and helps me with any problems I might have.

After having tried numerous diet programs (Nutrisystem, Weight Watchers) and even trying a trainer at the gym, I was very frustrated that weight was not coming off as easy as the actresses on TV. Through a recommendation from my doctor, Weight No More℠ was suggested. Lori has taught me more than just being on a diet, but has taught me how to change my way of eating and how to look at food differently. The weight started coming off and even 7 months later weight is still coming off! Weight No More teaches you about how to change your way of eating and not just temporarily but teaches you how to eat for the rest of your life. I can't thank Lori enough for her support and encouragement! I would highly recommend Weight No More℠ Diet center to anyone who has tried it all and hasn't gotten the results they want! Weight No More℠ will be the solution you are looking for!

Thank you for helping me to change my eating habits so that I finally lost weight after yoyo-ing for many years. I was surprised to see how satisfied I felt on your program. All the staff members have been very helpful and encouraging. They've provided many useful tips and recommended excellent food and snack choices that have made my weight loss journey successful. I feel confident that I will be able to maintain my weight loss, and I appreciate all your help.

I loved the program! The pounds really came off steadily, as promised. Ten pounds came off the first month, which was very exciting and motivating. The staff helps you find foods that you like so the menu appeals to you, and you are eating every 2-3 hours so you don't feel deprived. I lost 20 pounds ... my clothes fit great. I can wear shirts tucked into my skirt and am looking forward to getting a bathing suit for the summer.

If you're ready to face facts and do the work, then the program at Weight No More is for you. Learn to eat correctly with only real food and with the guidance needed to get you through any difficult eating situation. I was able to eat and lose through the winter holidays, birthdays, anniversaries and graduations! Lori and her staff will help you eat out, attend parties and still LOSE the weight. I'm now 60 and in the same size I wore at 40 while eating well. My physician recommended this program, and she was right!!! You've heard this before: Just do it.

Lori, I Just want to thank you for giving me back my figure. Never got so many compliments ever. People think I did cosmetic surgery because my face looks so good. And overall, it's a big accomplishment at my age to turn the clock back a little. My skin looks better to them because you taught me how important water is. Thanks so much. My husband is also very proud of my weight loss.

Lori, I wanted to take the opportunity to thank you two-fold.

A little over two years ago I came to you as a client. You delivered superb service that resulted in my losing 30 pounds gained the previous year. You gave me a unique education about food and gave me tools that I can effectively use for the rest of my life.

Eight months ago, I gave you a referral. As always, you were so good at what you do that I was thanked profusely by the person I referred.

I sincerely thank you for being a person of integrity, honesty, skill and for being a consummate professional.

I am very happy with the program at Weight No More℠ Diet Center. There are no crazy gimmicks used. Everything is regular food that you buy in the grocery store. This is not a fad diet. It is a way of life. I learned the right way to balance out what I eat during the day. I have lost a lot of weight and have never felt better.

I can’t believe that I am a size 4 AND that I have kept my weight off for over a year! This program is the best. It is easy to follow during weight loss and also during maintenance if you simply surrender yourself to Lori and her team. I am grateful for all of the extra time I have now that I am not obsessing about my weight.

For the first time I finally feel that food is not an issue. I have learned how to eat healthy and I know that I will keep it off. This program is really about eating well, bringing all healthy foods, fruits, vegetables and whole grains back into your diet, the way it should be! I am so happy, and I feel really great. It has been the best year for me. I lost 56 pounds, and I am now on the Maintenance Program to keep it off for good!

The program is amazing. It is a program that enables you to learn how to eat for the rest of your life and is easy to follow long-term because you don’t feel you are missing out on things. The personalized attention of one-on-one meetings really helps to keep you focused and driven, and even when you slip up or don’t lose weight, they still keep you going and keep you motivated.

I created new eating habits and changed my lifestyle completely with Weight No More Diet Center. I feel great!

I would like to thank Weight No More Diet Center for helping me lose the weight I desperately needed to lose. Lori, Simi and Marci are a great support. They are very encouraging and are always there to listen. I have lost 80 pounds in 9 months. I went from a size 18 to a size 4. I never thought I could do it, but I did. The program has changed my life for the better. I have changed my eating habits. I feel good and I am very proud of myself.. A very big thank you to Weight No More!

It’s pretty obvious to most people that if a healthy person wants to lose weight, it won’t happen without some effort and commitment. If you do make the decision to lose weight, I found the Weight No More Diet Center method works. You won’t starve or feel hungry, and the pounds come off! The program allows a wide range of foods with a large variety to choose from, including an extensive list of Kosher certified products for those who observe Kashrut. I have been working with Rosalie Shatzman and have found her to be supportive and knowledgeable ... and very patient with my many quesitons. Bottom line: Follow the program and you will lose the weight.

Testimonials