Required fields *

Form stimulus Web
First Name*
Date of birth*
Name of Surgeon*
Date of operation*
Type of Surgery*
Current weight* Lbs Kgs
Starting weight* Lbs Kgs
Diabetes* never had improved cured insulin pills
Improved sleep apnea* never had yes no no apnea
Feeding difficulties* yes no liquid solid other
Hypertension* improved cured never had
Reflux:*   before operation *: yes no /   after opération * yes no
Reflux improved with medication* yes no
Hunger between meals* yes no
Satiety at the end of the meal* yes no
Exercise* yes no