(516) 400-4900
Practice Policy Update Regarding Covid-19

Bariatric Questionnaire

Bariatric Questionnaire

1. Have you thoroughly explored other treatments for obesity?
2. How much weight do you want to lose?
3. What is your gender?
4. What's Your Body Mass Index
(Calculate your BMI)
5. Do you have any weight-related health issues
(diabetes, hypertension, sleep apnea, joint problems, etc)?
6. How do you feel about regular visits with a bariatric professional (doctor, dietician, etc)?
Email

Form submitted successfully!

You qualify for Medical Weight Loss, the Orbera gastric balloon, the Gastric Bypass, or the Sleeve Gastrectomy.

Form submitted successfully!

You qualify for Medical Weight Loss, the Orbera gastric balloon, the Gastric Bypass, or the Sleeve Gastrectomy if you have a condition related to Obesity (high blood pressure, diabetes, sleep apnea, etc.).

Form submitted successfully!

You qualify for Medical Weight Loss and the Orbera gastric balloon

Form submitted successfully!

You qualify for our Medical Weight Loss program. Please click here to learn more.

  • HOME
  • PATIENT PORTAL
    • 33 Walt Whitman Rd., Suite 300B, Huntington Station, NY
    © 2020 - Clarity Surgical and Weight Loss Solutions - All Rights Reserved - Accessbility Statement - Sitemap
    Powered by Roya