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Surgery Interest? * Gastrict SleveGastric BypassDuodenal SwitchMini Gastric BypassUndecidedGastric Balloon - InGastric Balloon - OutGastric Balloon AdjustmentLap-BandLap-Band RemovalLap-Band RevisionRevision: Gastric Sleeve to Gastric BypassRevision: Gastric Sleeve to Duodenal SwitchRevision: Gastric Sleeve to Mini Gastric BypassRevision: RNY Gastric Bypass Any Previous Weight Loss Surgery? * NoYes Any Previous Open Abdominal Surgery? * NoOtherAppendixC-SectionGallbladderHiatal Hernia Do you take any medication? * NoYes Do You Have Heart Conditions? * NoArrhythmiaCardiac ArrestClotting DisorderCongenital Heart DiseaseCongestive Heart FailureCoronary Artery DiseaseHeart AttackHeart Valve DiseasePeripheral Artery DiseaseOther Do you have reflux or indigestion? * NoOtherCrohn'sDiverticulitisUlcerative Colitis
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Full Name * Date of Birth * Weight (Lbs.) * Height (Feet / Inches) * Select Feet4567 Select Inches0123456789 Do you have any allergies? * NoYes Allergies Any reflux or indigestion? Any previous surgeries? Any heart problem? Do you take any medication? Email * Phone Number * How Did You Hear About stopobesity.us? * SelectReferral From A FriendReferral From A Family MemberFacebook GroupTikTokGoogle SearchGoogle AdsHeard About You From Another Post OnlineHeard About You From An Article