Get Gastric Bypass Pre-surgical Psychological Evaluation Intake Form

Completing the gastric bypass pre-surgical psychological evaluation intake form online is an essential step in your weight loss journey. This guide will help you fill out the form accurately, ensuring that you provide all necessary information for your evaluation.

Follow the steps to complete the intake form effectively.

1. Click the ‘Get Form’ button to access the intake form and open it for completion.
2. Begin by entering your personal data in the designated fields. This includes your name, address, email, phone numbers, and date of birth. Ensure all details are accurate.
3. Complete the 'Main Concerns' section by listing the primary reasons you are seeking gastric bypass surgery. Rate the importance of each reason using the provided scale from 1 to 10.
4. In the 'Health Care Providers' section, fill in the names and contact details of your various health care providers, including specialists you have seen.
5. Provide information regarding any prior surgeries, hospitalizations, or significant injuries you have experienced.
6. List all medications you are currently taking, including any over-the-counter medications, and any allergies you may have.
7. Complete the weight history section, including your current and past weights, as well as any family history of weight issues.
8. Fill out the dieting history table with weight loss programs you have previously tried, including durations and outcomes.
9. Answer questions related to your nutrition and food habits, indicating your typical eating patterns and preferences.
10. Provide information about your exercise status, preferences, and goals related to bariatric surgery.
11. Articulate your greatest fears and hopes regarding the surgery, along with who you expect to support or oppose your weight loss efforts.
12. Review your completed form for any errors or omissions before saving your changes, downloading, printing, or sharing the form.

Complete your gastric bypass intake form online to take the next step in your health journey.