Filling this form does not obligate you in any way. You can fill the form even if you haven’t decided or are not sure if you need a bariatric surgery.
Age
Height (cm)
Current weight (kg)
Highest lifetime weight (kg)
List all medical conditions, including heart, chronic illnesses, gastric, and etc.
Full Name
E-mail
Phone number (with country code)
Additional information or questions
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