Thank you for your interest in our healthy living and weight loss study.  This study involves participating in a 30-day trial, completing questionnaires, providing finger prick blood samples, and 4 visits to our downtown Toronto clinic. Participants are provided nutritional supplements and shakes (over $400 value) and will receive $150 if they successfully complete the study.

Please answer the following questions so that we can determine if you are eligible to participate in the study.  Completion of this survey is entirely voluntary and you can choose to discontinue the survey at any time.  Your answers will be kept confidential except as required by law.

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* 1. What is your first name?

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* 2. What is your last name?

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* 3. What is your email address?

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* 4. What is your phone number?

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* 5. Are you male, female or non-binary?

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* 6. Are you currently pregnant, planning to become pregnant, or breastfeeding?

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* 7. What is your birthdate (day/month/year)?

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* 8. What is your height? (cm or ft&in)

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* 9. Unit

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* 10. What is your weight? (kg or lb)

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* 11. Unit

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* 12. Do you take any medications daily?

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* 13. Have you participated in a weight loss program or diet in the past 3 months? (for example Weight Watchers, Jenny Craig, DASH diet, Atkins, etc.)

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* 14. Do you provide us with your consent to maintain your personal information provided in this survey within our database and to be contacted for future studies?

Thank you for completing the survey!  We will email you within the next 2 business days about your eligibility for this study.
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