Causes of
Obesity
Treatment
Options
Life After
Surgery

Am I a Surgical Candidate?

All information you provide below is optional. By submitting your information, you agree that it will be governed by our Privacy Policy.

The form below will help you better understand if you meet the National Institutes of Health primary guidelines for weight loss surgery. It may also serve as a guide in speaking with a bariatric surgeon in your area.

First Name:
Last Name:
Phone:
email:
Date of Birth:
 19
Gender:
Height:
 Feet Inches
Weight:
 lbs
BMI:
 Enter the results from the calculator below

How To Use The Calculator

Select your gender, and then move the red slider handles or select your height and weight to calculate your BMI.

The results of the BMI calculations are displayed below. Note that these are approximate values, and are to be used only as a rough guide.

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Gender:
Height: ' "
Weight: lbs
BMI:
Ideal Weight: - lbs
Assessment:

Do you suffer from any of the following conditions?

Diabetes
Heart Disease(Including:
Coronary Artery Disease, Angina,
Congestive Heart Failure (CHF),
High Blood Pressure (Hypertension) Hyperlipidemia
High Cholesterol
High Triglycerides
Pulmonary (lung) Disease
Pulmonary Hypertension
Sleep Apnea Syndrome (SAS)
Obesity Hypoventilation
Syndrome (OHS)
Asthma/Bronchitis
Female Hormone Dysfunction
Gallbladder Disease
Cirrhosis(“Hardening” of the liver,
not related to drinking alcohol)
Steototic hepatitis
(“Fatty Liver”)
Arthritis
Hypercoaguability(Blood That
Clots Too Easily or Frequently)
 Venous Stasis
Ulcers
Deep Vein Thrombosis
(Blood Clot)
Pulmonary Embolus(Blood Clot
That Goes to the Lung)
Psuedotumor Cerebrii
Stress Urinary Incontinence
Gastro-Esophageal Reflux
Disease(“Heartburn”)
Nephrotic Syndrome
(Kidney Disease)
Necrotizing Panniculitis
Fungal and other Dermatitis
(Skin Inflammation)
Hernias
Cancer
Psychiatric Conditions
Depression
Social Isolation