Alabama Bariatrics - 60 Second Assessment Quiz

1

I am...* This field is required.

Male

Female

2

Do you struggle to maintain a healthy weight using only diet and exercise?* This field is required.

Yes

No

3

Optional: Do you suffer from any of these common health issues?Select all that apply then click "Next."

Heartburn / Acid Reflux

Sleep Apnea

Diabetes

Depression

High Blood Pressure

Joint / Bone Issues

4

What is your weight and height?* This field is required.

Weight

Height (ft)

Height (in)

5

What is your biggest challenge or question right now?* This field is required.

Can I afford it?

Is surgery right for me?

Will I keep the weight off long-term?

6

Which payment option describes you best?* This field is required.

Self-Pay / Financing

Private Insurance

7

Have you decided which treatment is right for you?* This field is required.

Not Sure Yet

Gastric Bypass

Gastric Sleeve

Duodenal Switch

8

Where are you in your weight loss surgery decision process?* This field is required.

1. Researching

2. Evaluating Treatments

3. Choosing my Surgeon

4. Ready to Book a Consult

9

Thanks For Taking Our 60 Second Quiz!* This field is required.This assessment is not intended to replace or substitute for a professional medical advice, diagnosis, or treatment. By providing your phone number you agree to receive calls and texts from Alabama Bariatrics.

First Name

Last Name

Email

Phone