Follow the steps to successfully complete the questionnaire

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your full name in the designated field. This is crucial for identifying your record.
3. Indicate your gender by selecting either ‘Male’ or ‘Female’. If you prefer not to specify, you may leave this section blank.
4. Provide your date of birth using the format MM/DD/YYYY. Ensure the date is accurate for your medical records.
5. Select how long ago your surgery occurred from the available options or specify a different duration if needed.
6. Indicate the type of surgery you underwent by checking the appropriate box or writing it in if it is not listed.
7. Fill in your pre-surgery height and weight, along with your current weight to assess your weight loss progress.
8. Review and check any symptoms you are experiencing since your last visit, such as abdominal pain or nausea. Provide explanations where necessary.
9. Document the date of your last visit to your primary care provider and the date of your next visit.
10. Select which bariatric meal plan you are currently following from the available stages.
11. Assess your healthy eating habits by choosing one of the options provided.
12. Estimate the portion size of your meals in the appropriate space provided.
13. Record the amount of non-carbonated and non-caffeinated fluids you consume daily.
14. List all food and beverages consumed in the last 24 hours for accurate tracking of dietary habits.
15. Detail your exercise program, including the type of exercise, frequency, and duration.
16. List any medications you are currently taking, including multivitamins and any acid blockers.
17. Lastly, include any additional concerns or problems that may need to be addressed.
18. After filling out all sections, review your responses for accuracy and completeness. You may then save changes, download, print, or share the form as needed.

Complete your Guthrie Weight Loss Questionnaire online to ensure personalized care and support.