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Bariatric History & Physical Form To be completed by the patientTodays Date: Name: DOB: FirstMiddleLastPrimary Care Physician (PCP): Office Phone #: Preferred Pharmacy: Phone #: Fax #: Pharmacy Address:

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How to fill out bariatric history amp physical

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To fill out a bariatric history and physical form, follow these steps: 1. Start by providing your personal information such as name, date of birth, address, contact details, and insurance information. 2. Fill in your medical history, including any previous surgeries, medical conditions, allergies, and medications you are currently taking. 3. Next, answer questions related to your weight loss journey, such as your current weight, height, previous weight loss methods tried, and any success or challenges you have encountered. 4. Provide information about your dietary habits, exercise routine, and lifestyle choices. 5. Answer questions about any psychological or emotional factors that may be impacting your weight and overall health. 6. Finally, review the form for accuracy and completeness before submitting it to your healthcare provider.

Who needs bariatric history amp physical?

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Individuals who are considering or planning to undergo bariatric surgery or weight loss treatment may need to fill out a bariatric history and physical form. This form helps healthcare providers assess the patient's overall health, medical history, and suitability for bariatric procedures. It is an important document for both the patient and the healthcare team involved in the weight loss journey.

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