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Richard F. Sethre, Pay. D., L.P. 1405 Lilac Dr. N., Suite 160F Golden Valley, MN 55422 6124600692, fax: 6122344586 restore mhconcierge.com BARIATRIC INTAKE FORM (you may write in the notes section

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How to fill out bariatric intake form

01

Step 1: Begin by reading through the bariatric intake form thoroughly to understand the information it requires.

02

Step 2: Gather all the necessary documents and information that will be needed to fill out the form, such as medical history, current medications, and any previous surgeries related to bariatric procedures.

03

Step 3: Start filling out the form by providing your personal information, such as name, contact information, and date of birth.

04

Step 4: Move on to the section asking for your medical history. Be as detailed as possible, including any existing health conditions, previous surgeries, and any medications you are currently taking.

05

Step 5: Answer the questions related to your lifestyle and habits, such as smoking, alcohol consumption, and exercise routine.

06

Step 6: If applicable, provide information about any previous bariatric procedures you may have had.

07

Step 7: Carefully review the completed form to ensure all the information is accurate and complete.

08

Step 8: Submit the form to the designated healthcare professional or institution as instructed.

Who needs bariatric intake form?

01

Anyone who is considering or has been recommended for bariatric surgery will typically need to fill out a bariatric intake form. This form helps healthcare professionals gather necessary information about the patient's medical history, current health conditions, and lifestyle habits. It allows the medical team to assess the patient's eligibility for bariatric surgery and provides important details to ensure safe and effective treatment.

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What is bariatric intake form?

A bariatric intake form is a document used to collect necessary information from patients undergoing bariatric surgery to assess their eligibility and prepare for the procedure.

Who is required to file bariatric intake form?

Patients who are seeking bariatric surgery or weight loss procedures are required to file a bariatric intake form.

How to fill out bariatric intake form?

To fill out a bariatric intake form, patients should provide accurate personal information, medical history, current health status, and any previous weight loss attempts or treatments.

What is the purpose of bariatric intake form?

The purpose of the bariatric intake form is to gather comprehensive information about the patient's health and weight history to determine suitability for surgery and to create a tailored treatment plan.

What information must be reported on bariatric intake form?

Information that must be reported includes personal details, medical history, weight history, current medications, and lifestyle habits such as diet and exercise.

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