Torch Follow-Up Consult Survey
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Patient ID
*
What is your current weight?
*
lbs
Have you been taking your medication daily?
*
Yes
No
Give your doctor feedback on the medication. Have you experienced changes in appetite, fullness, or cravings? Have you experienced side-effects?
Do you want to continue this medication? Why or why not?
Have you begun taking any other new medications since your last consult, e.g. new medication for a condition unrelated to weight loss?
Have you experienced changes with your allergies since your last consult, e.g. developed new allergies?
Have you experienced changes with medical conditions since your last consult, e.g. another doctor diagnosed you with a new condition?
Submit
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