Questionnaire weight-loss surgery Step 1 of 4 - Personal Information 25% Your Name* Your Surname* E-Mail* Phone*Date of Birth* How did you hear about us?* Recommendation I am already a medicalfly patient Google Ads Google Facebook Instagram YouTube Influencer Height* Weight* Gender* Male Female Diverse When Can We Call You Back?* In which language would you like to receive advice?* German English Turkish Diabetes* Yes No high blood pressure* Yes No Hypothyroidism* Yes No Hyperthyroidism* Yes No Arrhythmia* Yes No Are you taking the pill or any other hormones?* Yes No Please enter the name* Do you smoke?* Yes No How many cigarettes do you smoke a day?* Have you had an outpatient or inpatient stay in the hospital, an operation, medical care or a pregnancy in the past 18 months?* Yes No What was the reason?* Please write down any other operations you have had (optional) Have you ever had an operation under general or partial anesthesia?* Yes No Type of operation / date of operation* Do you use medication?* Yes No What medications do you use?* When would be your preferred date for the operation?* DD slash MM slash YYYY CAPTCHA
