NewFit Qualification Quiz

How much weight do you want to lose?

a. A lot - about half of my current weight

b. Moderate - about 25-30% of my current weight

c. Not Sure - I just want to be healthy

Have you thoroughly explored other treatments for obesity?

a.Yes - I have tried one or more diet and exercise programs

b.I've dabbled, but never really gotten serious about it

c.No

What is your gender?

a.Male

b.Female

1. Enter your Height:

Units:

2. Enter Your Weight:

Units:

lbs

Do you have any weight-related health issues? Check all that apply:

Asthma

Cardiovascular disease

Degenerative joint disease

Depression

High cholesterol

GERD

Gout

Hypertension

Metabolic syndrome

Migraines

Non-alcoholic fatty liver disease

Obstructive sleep apnea

Polycystic ovarian syndrome

Pseudotumor cerebri

Type II diabetes mellitus

Stress urinary incontinence

Venous stasis disease

Age

a.Under 18

b.18 - 25

c.26 - 50

d.51 - 64

e.Over 65

How do you feel about regular visits with a bariatric professional (doctor, dietician, etc.)?

a.I don't have any problem seeing a professional regularly

b.Limiting my visits is important to me

c.I hate the doctor

How severe are your food cravings?

a.Frequent and strong

b.Occasional

c.I don't necessarily crave food other than normal hunger

Are you on anticoagulation medication (blood thinners)?

a.Yes

b.No

c.I don't know

Are you willing to be on a serious regimen of vitamins and supplements?

a.Yes - as long as the procedure leads to more weight loss and health improvement.

b.No - I am not sure that I can commit to lifelong supplements.

Contact Us

First Name* :

Last Name* :

Email* :

Telephone Number* :

Do you have insurance that covers bariatric surgery?*

*Required Fields

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