Get Comprehensive Obesity Management Program Patient History Form - Gbmc

Completing the Comprehensive Obesity Management Program Patient History Form online is an essential step in your journey towards effective obesity management. This guide provides detailed instructions to help you navigate each section of the form confidently.

Follow the steps to accurately fill out the form online:

1. Press the 'Get Form' button to access the Comprehensive Obesity Management Program Patient History Form and open it to begin filling it out.
2. Enter your personal information in the appropriate fields, including your name, date of birth, and contact information. Make sure to provide accurate details regarding your marital status and occupation.
3. Indicate your height and goal weight. Provide your current weight and mention the age at which you last achieved your goal weight.
4. If applicable, note any spiritual practices that may influence your medical care plan.
5. In the family history section, check relevant conditions that your blood relatives have experienced, noting the specific family member affected.
6. For your medical history, record details from your last physical exam and list all medications you are currently taking, including any reactions to medications that you have experienced.
7. Provide details about your sleep patterns, research to see if you have had a sleep study, and complete the Epworth Sleepiness Scale.
8. Mark any relevant respiratory, musculoskeletal, nervous system, gastrointestinal, cardiac, endocrine, ear and nose, blood disorders, vascular, genitourinary, and OB/GYN conditions that apply.
9. Summarize your cancer history and provide your social history by stating your smoking and drinking habits along with any other substances used.
10. Summarize your surgical history and any past gastric surgeries or hospitalizations.
11. Describe your weight history and dieting attempts, categorizing your previous weight classifications at various ages.
12. Discuss your eating behaviors, food intolerances, typical eating patterns, and physical activity assessments to provide a comprehensive picture of your health.
13. Finally, reflect on your psychosocial history regarding mental health, support systems, weight loss readiness, and list your healthcare providers.
14. After completing all sections, review your responses for accuracy, then save the changes, download a copy, print the form, or share it as required.

Start filling out the Comprehensive Obesity Management Program Patient History Form online today to take your first step towards better health!