Are you considering bariatric surgery?

How old are you?*

What diets have you tried?*

Whats the longest you've stuck with a diet?*

Have you talked to your GP about your weight?*

Do you know your BMI?*

Do you suffer from any of the below conditions?*

Do you feel like food controls your life?*

Are you willing to permanently change your life? (diet and exercise)*

Are you willing to attend post operative appointments?*

How much time have you taken to research weight loss surgery?*

Name*

First Last

Email*