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Stop the 21st Century Killing You
Stop the 21st Century Killing You
The Body Restoration Plan UK Paperback


The Body Restoration Plan US ed.
US - click here to buy the book from

Dr Baillie-Hamilton’s Weight Management Survey

It would be fantastic to find out exactly how people’s lives have improved on the program. But to be able to do this we need to see progress details from as many people as possible so we can summarise the findings and eventually publish them, of course retaining your anonymity. So I would very much appreciate it if you could take a couple of minutes to fill in as much of the form below as you can and send it back to me using the Submit button at the end. Please note that no individual details will be published - only summary details.

I am Male     Female
My age range is
17 or under
65 or over

Were you overweight before starting the diet? Yes      No      Don't Know
Are you actively trying to lose weight? Yes      No
Are you actively trying to improve your health? Yes      No

How many other diets have you tried in the last 5 years?
0   1   2-4   5-9   More than 9
Please describe any other diets that you have been on  

How did you hear about the Detox Diet/Body Restoration Plan?
From a friend   From the Radio   On TV   Other   (Please Specify) 

Do you have any medical conditions?          Yes      No
If so, please describe       

How many of the recommended supplements are you taking?
All       Most       Some      None

Are you eating food low in Chemical calories? 
All the time       Most of the time       Some of the time      No

Are you restricting your food intake as suggested in the book? 
Yes       Partly           No

Which other products low in Chemical Calories are you using? (Please enter all that apply)
Toiletries       Household cleaning           Other   (Please Specify) 

How much exercise are you taking?
A lot       A moderate amount           A little            None

Please describe any other actions you are taking as recommended by the book:

Date you started program (format dd/mm/yyyy)
Date Today (format dd/mm/yyyy)
Total days duration on the program
Your Height
Your weight before starting program In Pounds     or in Kg
Your current weight In Pounds     or in Kg
Click here for the body fat calculator  
Your % body fat before starting program
Your current % body fat

Do you feel healthier now? Yes, a lot      Yes, a little      No      I feel worse

If you have experienced good health, could you describe this further:

Please add any comments you may have:



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