Home Patient Questionnaire
Gender
How long have you been struggling with your weight?
Were you an Obese Child?
Were you Obese as a teenager?
Diet Programs:
Medications for weight loss:
Physical Activities:
Family history of obesity:
How does your weight affect you:
Respiratory:
Cardiovascular:
Please take the time to scroll through the answers you have given before submitting your patient questionnaire form.
When you activate the "Submit" button below, you will successfully your survey to Sydney Metabolic Surgery
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Referral: