Age and Gender
How old are you?
What is your gender
Please Select
Female
Male
Non-Binary
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Height
Height (ft)
*
Height (inches)
*
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Weight
If you've already had surgery and are checking your progress, please use your pre-operative weight
What's your current weight (in lbs)?
*
What is the most you've ever weighed (in lbs)? (excluding pregnancy if you're female)
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Diabetes
Do you have diabetes?
Yes
No
Pre-diabetes
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GLP-1 Medications
Do you currently take any of the following medications?
Tirzepatide (Mounjaro or Zepbound)
Semaglutide Injections (Ozempic or Wegovy)
Semaglutide Pills (Rybelsus)
Liraglutide (Victoza)
Dulaglutide (Trulicity)
No, I don't take any of these medications
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GLP-1 Medications
Do you plan to continue to take {glp1Medications} after surgery?
No
Yes
Maybe
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Weight Gaining Medications
Amitryptiline (Elavil), Aripiprazole (Abilify), Clozapine (Clozaril), Imipramine (Tofanil), Lithium, Mirtazapine (Remron), Olanzapine (Zyprexa), Quetiapine (Seroquel), Risperidone (Risperdal), Valproate (Depakote)
Do you currently take any of the medications listed above?
No
Yes
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Past Surgery
Have you ever had Bariatric Surgery before?
Yes and I'm considering a revision
Yes, I'm checking if my results were as expected
No
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Surgery Interests
Which surgery are you most interested in?
Sleeve Gastrectomy (VSG)
Gastric Bypass
Lap Band
Duodenal Switch
SADI Procedure
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Health Insurance
Where do you get your health insurance?
Through either mine or my spouse's employer
I have Medicare or a Medicare Advantage plan
I purchase it through the marketplace or a similar vendor
I get it through the state (Medicaid, AHCCCS or similar)
I plan on self-paying for Bariatric Surgery
Who is your health insurance carrier?
Please Select
BlueCross BlueShield
Aetna
Cigna
United Healthcare
Humana
Other
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Get Your Results!
Check your email after you complete the quiz
First Name
Last Name
Email
*
Phone Number
Format: (000) 000-0000.
Postal/Zip Code
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Let us know what you're interested in
I'm interested in:
The Books
Nutrition Program
GLP-1 Medications
Bariatric Surgery
Please have someone from the Pound of Cure team contact me with more information
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