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Bariatric Surgery Screening Questions

To continue the bariatric surgery screening process, please answer the following questions based on the informational video.

Complete the Screening Questions

*First Name

*Last Name

*Date of Birth

*Email

*Phone Number

*Height

*Weight

*Where would you like to go for your surgery appointments?

*What are the two types of bariatric surgery we perform?

*Who is your first appointment with?

*Who are the key players on the bariatric team?

*True or False: Weight loss surgery is considered elective

*Are you required to quit smoking?

*The Baritastic App will help you through this journey. Which of the following does the app NOT do? Track food Set reminders Track steps Provide access to recipes and support groups Schedule appointments

*True or False: Weight loss surgery risks include nausea, vomiting, and dehydration.

*True or False: You will need to take supplements for the rest of your life after surgery.

*True or False: After weight loss surgery you are more likely to become pregnant unexpectedly.

*Which bariatric surgery video did you watch?

*Type your first and last name as agreement that you have watched this video in full.

PLEASE NOTE:

In order to qualify for bariatric surgery, you must meet the following BMI (body mass index) criteria: 35 or higher with comorbidity or 40 or higher without comorbidity. Comorbidity means that you have another illness or disorder in addition to obesity. Examples include diabetes, high blood pressure, high cholesterol, sleep apnea, or fatty liver.