Get Severe Obesity History Questionnaire - University Of Iowa ... - Uihealthcare

Completing the SEVERE OBESITY HISTORY QUESTIONNAIRE is an essential step towards receiving adequate support and evaluation for bariatric surgery. This guide provides clear instructions to ensure you can successfully fill out the form online.

Follow the steps to accurately fill out the questionnaire.

1. Click ‘Get Form’ button to obtain the questionnaire and open it in your editing tool of choice.
2. Begin by entering your personal information in the designated fields, including your name, age, date of birth, and contact details. Ensure that your information is accurate.
3. Provide your health history by marking any obesity-related complaints that apply to you, the medications you may be taking, and any conditions that are pertinent to your obesity.
4. Detail your psychiatric history if applicable. Indicate whether you see a healthcare provider for mental health issues and include any necessary documentation or evaluation reports.
5. List any other medical conditions you may have, along with the medications and dosages for each condition.
6. Fill out your surgical history explicitly, noting previous bariatric surgeries and submitting any related documents if applicable.
7. Indicate any drug allergies experienced along with reactions. This is crucial for ensuring safe medical treatment.
8. Complete the family history section by marking any relevant conditions, as this can indicate genetic predispositions.
9. Describe your weight gain pattern from age 18 to the present, including any significant changes due to pregnancies or diets.
10. Answer questions about your exercise history, detailing any regular activities or barriers preventing you from exercising.
11. Outline your dietary history by describing typical eating patterns and any habits that might contribute to weight issues.
12. Fill out your social and personal history including education, occupation, and marital status, providing a comprehensive background.
13. Document your weight loss attempts, listing supervised diet attempts along with durations and outcomes.
14. Finally, review your completed questionnaire for accuracy, save your changes, and proceed to download, print, or share the form as necessary.

Begin your journey towards improved health by filling out the SEVERE OBESITY HISTORY QUESTIONNAIRE online today.