Annabelle Vogel & Kollegen

Ihr Partner in Hanau

für Gesundheit & Prävention

German

Figurkompass – Monthly Status

Figurkompass – Monatlicher Status

Notify

Please ensure that your details match the information on your health insurance card (so that we can correctly identify you).

Questions marked with “*” are mandatory.

First name

Last name

Date of birth

Gender

Email

We’re glad you’re participating in the Figure Compass program.

Please answer the following questions about your progress in the last month.

Your current weight
in kg – please round to kg, e.g. 90

Has your eating behavior changed in the last month?
⭐yes, for the worse, ⭐⭐no, ⭐⭐⭐yes, for the better

yes, unfortunately for the worsenoyes, for the better

How satisfied are you with your weight development (in the last month)?
⭐not at all satisfied, ⭐⭐ satisfied, ⭐⭐⭐very satisfied

not at all satisfiedsatisfiedvery satisfied

Have you incorporated more exercise into your daily routine in the last month than before?
⭐no, ⭐⭐ yes, ⭐⭐⭐yes, a lot

noyesyes, a lot

Have you been dealing with stress better in the last month?
⭐- no, ⭐⭐ can’t say, ⭐⭐⭐ yes

nocan’t sayyes

Have your sleeping habits improved in the last month?
⭐- no, ⭐⭐ can’t say, ⭐⭐⭐ yes

nocan’t sayyes

How satisfied are you with the development of your goals in general (in the last month)?
⭐not at all satisfied, ⭐⭐satisfied, ⭐⭐⭐very satisfied

not at all satisfiedsatisfiedvery satisfied

Have you noticed any side effects in connection with the weight loss injection?

No

Yes, gastrointestinal complaints such as nausea, diarrhea, vomiting, or abdominal pain and bloating

Yes, headaches, fatigue and exhaustion

Yes, hypersensitivity reactions

Yes, hair loss

Other

Obesity Other

Do you have any other comments, annotations, or suggestions that have arisen in the last month?
We also welcome suggestions for improving the Figurkompass that would help you.

I would like to receive a copy of this form as a PDF by email (the PDF is in german, even though this questionnaire is in english for your convenience)

Yes

No

Email for form submission

Signature (I hereby confirm my details)

Es ist ungewohnt mit der Maus zu unterschreiben. Keine Sorge – Ihre Unterschrift ist trotzdem genauso gültig wie auf Papier.

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