Registration

Name and surname

E-mail address

Telephone number with the area code

Age

Body weight (kg)

Height (cm)

What are your main complaints at the moment?

What medications are you currently taking?

What is the reason for taking the above medications?

Which floor can you climb to without a break?

How far can you go on a flat surface?

Which surgeries, procedures or serious diseases have you had?

What do you expect from the surgical treatment of obesity?

I hereby give my consent for my personal data to be processed for the purposes related to the rendering the medical services by the EurObesity Clinic and affiliated entities. I acknowledge that revealing the data is voluntary. I was informed about my right to view and correct my personal data.