Age and Gender
How old are you?
What is your gender
Please Select
Female
Male
Non-Binary
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Height and Weight
Height (ft)
Height (inches)
What's your current weight (in lbs)?
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Diabetes
Do you have diabetes?
No
Yes, I am pre-diabetic and either don't take medications, or only take Metformin
Yes, I take medications for my diabetes, but do not use insulin
Yes, I use insulin or am about to start taking insulin
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GLP-1 Medications
What are your thoughts on using GLP-1 medications like Ozempic, Wegovy, Mounjaro or Zepbound after surgery?
If they helped me maintain my weight, I'd be happy to take them long-term
I'd consider it, but would rather not take medications long-term if I can avoid it
I do not want to take GLP-1 medications after surgery
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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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GERD
Do you experience heartburn or GERD symptoms?
No, almost never
Occasionally, but it's usually due to something I ate
Yes, a few times a week and it's bothersome
Yes, almost every day and it's awful
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NSAIDs
Do you take NSAID medications (Advil, Ibuprofen, Aspirin, Alleve, etc.)? Tylenol is not an NSAID and is not a factor after Bariatric Surgery.
Less than once per week
I take it a few times a week, but could easily stop or switch to Tylenol
I take NSAIDs almost every day, but could probably stop or switch to Tylenol
I am dependent on NSAIDs and can't stop taking them
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Upset Stomach
Do you suffer frequent episodes of an upset stomach?
No, almost never
Occasionally, but it's not bothersome
Yes, I have frequent stomach problems
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Abdominal Surgery History
Have you had abdominal surgery in the past?
No, Never
I've had minor surgery like gallbladder or appendix removal
I've had a major abdominal surgery in the past
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Alcohol use
Alcohol habits
I drink less than once per month
I drink less than once per week
I have 1-2 drinks per week
I have 2-5 drinks per week
I drink alcohol almost every day
I have 2 or more drinks every day
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Smoking
Do you smoke cigarettes?
No
I used to, but I quit
Yes, I currently smoke
Do you vape?
No
I used to, but I quit
Yes, I currently vape
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Smoking
How much do you smoke?
I don't smoke every day
A few cigarettes a day
1/2 pack per day
1 pack per day or more
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Smoking
How certain are you that you could quit smoking, forever?
I am certain that I can quit smoking
I think I can quit, but I'm not 100%
I'll try, but it's unlikely
I'm not willing to quit
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Vaping
How often do you vape?
I don't vape every day
1-5 times per day
5+ times per day
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What's Important to You?
Drag and Drop these in order of importance
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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
Cigna
Aetna
Humana
United Healthcare
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
Nutritional Counseling
GLP-1 Medications
Bariatric Surgery Consultation
Please have someone from the Pound of Cure team contact me with more information
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