Ancestral Weight Loss Registry
  • Home
  • Join
  • Results
  • Testimonials
  • Science
  • Blog
  • About
Questionnaire
Results

Please answer each question as completely and accurately as possible. 
All information will remain confidential. Private information will never be revealed to anybody without your consent. The aggregate anonymized data may be used to discover trends and commonalities among all registry members.
Read Privacy Policy


Before and after pictures preferred but not required.
You can upload before and after pictures at the end of the questionnaire if you lost or gained weight. The data we receive with these pictures will be analyzed separately since it is of higher integrity. The photos are also needed to be featured on the blog.

    DEMOGRAPHICS

    No spam we promise. Just want to keep you in the loop when we discover something new! 1 email per month maximum.

    LOCATION


    WEIGHT & WEIGHT LOSS


    DIET & EXERCISE CHARACTERISTICS

    Check all that apply
    Check all that apply

    HEALTH CHANGES

    Check all that apply
    Select all that apply.
    Check all that apply

    FOODS


    PRESCRIPTION DRUGS AND DIET-DRUG INTERACTIONS

    Please be as thorough as possible with your medications. We are curious to see if paleo or low carb nutrition has any effect on your prescription drugs. If you do not take any medications, you can scroll down to the Free Response portion.
    Which disease was it prescribed for?
    The amount of pills, tablets, teaspoons etc. Units can be entered in next box.
    For which disease was it prescribed?
    The amount of pills, tablets, teaspoons etc. Units can be entered in next box.

    Which disease was it prescribed for?
    The amount of pills, tablets, teaspoons etc. Units can be entered in next box.
    Which disease was it prescribed for?
    The amount of pills, tablets, teaspoons etc. Units can be entered in next box.

    Which disease was it prescribed for?
    The amount of pills, tablets, teaspoons etc. Units can be entered in next box.
    Which disease was it prescribed for?
    The amount of pills, tablets, teaspoons etc. Units can be entered in next box.

    Examples might include: did you save money or spend more on medications? Any issues with taking medications in general on a low carb or paleo diet?

    FREE RESPONSE

    Spill your heart out!
    Please check out the privacy policy and terms of service. They will open in a new window. Private information will never be revealed to anybody without your consent.
Submit
Powered by Create your own unique website with customizable templates.