AplicaciondeCirugia

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Unit of measurement | Height and Weight

Height (ft)

Height (Meters)

Do you use tobacco, marijuana, electronic cigarettes?

How often do you consume it?

Do you consume alcoholic beverages?

How often do you consume them?

Are you currently taking any medications?

Please indicate how often you take the medication:

Are you currently taking a 2nd medication?

Please indicate how often you take the 2nd medication:

Are you currently taking a 3rd medication?

Please indicate how often you take the 3rd medication:

Are you currently taking a 4th medication?

Please indicate how often you take the 4th medication:

Have you been pregnant?

How many pregnancies have you had?

Have you had previous bariatric surgeries?

Are you currently suffering from stomach reflux?

Have you had previous surgeries other than bariatric surgeries?

Body Art BARIATRICS