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ABOUT
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PLASTIC SURGERY
Body
Liposuction
Tummy tuck
Buttock augmentation
Brazilian Butt Lift
Thigh lift
Pectoral implants
Body Shape Surgery Before and After
Breast
Breast Implants
Breast lipofilling
Breast lift
Breast reduction
Gynecomastia
Gigantomastia
Breast Surgery Before and After
Face
Face lift
Facial lipofilling
Rhinoplasty
Blepharoplasty
Otoplasty
Genioplasty
Hairline Lowering Surgery
Mannequin Clamp
Facial Surgery Before and After
Aesthetic
Cryolipolysis
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Lasik
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Stretch Mark Treatment
Hyperhidrosis Treatment
Hair Mesotherapy
Intimate surgery
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Hair transplant
FAQ Hair Transplant
Obesity
Gastric sleeve
Gastric bypass
Gastric band
Gastric Balloon
Nissen Sleeve
Bariatric Surgery Before and After
FAQ BARIATRIC SURGERY
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Tooth Whitening Before and After
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BARIATRIC SURGERY FORM
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LAST NAME AND SURNAME
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First
Last
DATE OF BIRTH
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Date Format: DD slash MM slash YYYY
Email
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Phone
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Medical information
Desired intervention
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Your current weight (in Kg)
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What maximum your maximum weight reached? (in kg)
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Your Height (in cm)
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Waist size
Your waist measurement (in cm)
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Duration of evolution of obesity
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What are your eating habits?
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Mostly Sweet
Mostly Salty
Salty and sweet
Fatty meals (Fast Food, etc.)
Do you consume sweetened liquids?
Not often
Yes
No
Do you eat large meals often?
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Not often
Yes
No
Do you snack?
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Not often
Yes
No
What do you eat between meals?
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Do you drink alcohol in large quantities?
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Not often
Yes
No
How many meals a day do you eat? and at what time of day?
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Other comments on your eating habits? Please specify
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Do you have associated diseases (diabetes, hypertension, coronary insufficiency, endocrine diseases, joint diseases, sleep apnea, respiratory diseases, cancers, infertility, psychiatric diseases, others…)? Please specify
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Do you have any digestive diseases (gastroesophageal reflux disease, ulcer, cirrhosis, Crohn's disease, tumours, other…)? Please specify
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Do you take long-term medication? Please specify
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Do you have any allergies (medicinal, other…)? Please specify
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Have you ever had any surgery? thank you for specifying (nature, by which way ..)
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Have you ever had surgery for obesity? Please specify (date, nature, approach, result, complications, etc.)
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Is obesity hereditary? Please specify
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