Patient Forms
Below are a list of forms and questionnaires for those considering weight loss surgery. Please open the files (Acrobat files) and read over the material carefully. Make notes of any questions that you have for the doctor.
Forms and Questionnaires:
- BMI Calculator — Candidates for obesity surgery must be at least 100 pounds over their ideal weight and have a body mass index (BMI) greater than 40. Patients may also be eligible for surgery if their BMI is greater than 35 with two or more obesity-related diseases, such as diabetes, gastroesophageal reflux disease, hypertension, depression and/or sleep apnea.
- Medical History Form
- Bariatric Nutrition Questionnaire
- Fact Sheet about Weight Loss Surgery
- Self-Exam Questions about Weight Loss Surgery
- Patient Letter from Dr. Anwar
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