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APPLY FOR SURGERY

Please Fill out and e-mail back or give to the Doctor BEFORE surgery. This is helpful info for the doctor to have, especially if you have any other medical problems. You always want your surgeon to be well-informed

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Pre-Operative Assessment

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For the Following Questions, Please Indicate "Yes" "No" or "Do Not Know". Please answer all of the questions.

1. Do you currently take any of the following medications?

3. Do you currently have any problems with your:

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The recommended surgery for obese patients with GERD or severe acid reflux is the Gastric Bypass. The bypass is the anti reflux surgery for weight loss. The sleeve can actually cause more reflux that may or may not be controlled with medication. In the case that the reflux is not controlled by medication you will need to consider converting your sleeve into a gastric bypass to prevent serious repercussions from the acids