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Bariatric Questionnaire

Bariatric Questionnaire

1. Have you thoroughly explored other treatments for obesity?
2. How much weight do you want to lose?
3. What's Your Body Mass Index
(Calculate your BMI)
4. Do you have any weight-related health issues
(diabetes, hypertension, sleep apnea, joint problems, etc)?
Email

Form submitted successfully!

Thank you for submitting your information.

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

Please contact us at (516) 400-4509 to schedule your consultation. We look forward to helping you and providing excellent care.

Form submitted successfully!

Thank you for submitting your information.

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.).

Please contact us at (516) 400-4509 to schedule your consultation. We look forward to helping you and providing excellent care.

Form submitted successfully!

Thank you for submitting your information.

You qualify for Medical Weight Loss and the Orbera gastric balloon.

Please contact us at (516) 400-4509 to schedule your consultation. We look forward to helping you and providing excellent care.

Form submitted successfully!

Thank you for submitting your information.

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

Please contact us at (516) 400-4509 to schedule your consultation. We look forward to helping you and providing excellent care.

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