Am I a Suitable Candidate for Weight Loss Surgery?

Ask yourself the following questions as a first indication as to whether the weight loss surgical procedure is the best solution for you to achieve long term sustained weight loss results.

Preliminary Medical Form

Answers

How old are you?

What is your gender?

What is your weight?

What is your height?

Have you been diagnosed with any of the medical complications below in relation to excess weight?

	Type 2 Diabetes		High Blood Pressure
	High Cholesterol		Sleep Apnoea
	Osteoarthritis		Depression
	Gastro Oesophageal Reflux Disorder (GORD)		Asthma
	Other Respiratory Tract Problem		Stress Urinary Incontinence
	Polycystic Ovarian Syndrome (PCOS) or Infertility

Have you made attempts to lose weight in the past either through diet and exercise or other therapies designed to induce weight loss?

I enjoy playing in the park with my kids

Can I sit behind the driver’s seat of my car?

Do I make the same New Year’s resolution to lose weight or I don’t bother anymore?

Do I avoid being photographed?

Do I snore?

Do my knees and ankles ache?

Is this all too depressing?