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Gastric Banding Form


Home Gastric Banding Form
Gastric Banding Form















Monday to Friday at 8h30 to 16h30



Procedure











Personal information







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State of Obesity





Medical history

Do you have or have you ever had any of the following

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Surgeries History

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Allergy

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Gynaecological and obstetric records

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Psychological State

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Since when have you been convinced of the chosen procedure ?


Medical Treatments

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Important : If yes, please list the medicines :




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Testimonials
For testimonials please have a look on our guestbook and do not hesitate to get in touch with our former clients.
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