POST SEMINAR QUIZ

Name:
Address:
City:
State:
Zip:
Phone:
Email:
Type of Insurance:
How did you hear about our program?

Read each question carefully and then choose the best answer:

1. Some of the health risks of obesity include:

a. headaches, nausea, palpitations
b. high blood pressure, diabetes, joint pain
c. shingles, glaucoma, psoriasis

2. Which of the following are related to morbid obesity:

a. Obesity is the 2nd leading cause of preventable death
b. The morbidly obese die 10-15 years sooner than non-obese people
c. Both a and b

3. The 3 main causes of morbid obesity are genetics, behavior, and environmental.

T or
F

4. The types of weight loss surgery include restrictive, malabsorptive and combination:

T or
F

5. Gastric Bypass surgery is an example of

a. Restrictive only
b. Malabsorptive only
c. Combination of restrictive and malabsorptive

6. Lap Band Surgery is an example of

a. Restrictive only
b. Malabsorptive only
c. Combination of restrictive and adjustable

7. Which surgeries do you need to take daily multiple vitamins?

a. Gastric Bypass
b. Lap Band
c. Both a and b

8. Hope Bariatrics is a Centers of Excellence facility.

T or
F

9. The Lap Band system:

a.   Is adjustable
b.   restricts the amount of food you can eat
c.   uses an access port beneath the skin to make adjustments
d. all of the above

10. One must be committed to make lifestyle changes for success:

T or
F

And finally... On July 6, 2001, the U.S. Government passed compliance regulations (HIPAA LAWS) that mandate all healthcare facilities protect health information and inform consumers of the healthcare information practices of the facility. At this facility, we have always, and will continue to protect the privacy of your health information.

Your privacy is important to us. Please indicate below if we are able to leave a message on your answering machine or voicemail. Thank you.

Yes, you may leave messages
No, please do not leave any messages

PATIENT TESTIMONIAL

Joe, 53 years old Gastric Bypass, November, 2008, Dr. Felix I knew I had to do something when my family doctor gave me 3 options a)Fantasy Island (FAT camp) b) a Pine Box or c) the surgery. I also have a 12 year old daughter that I want to walk down the aisle without a cane, crutch or walker. Lastly, I want to have a quality of life with the women that I love as we approach our senior years that is filled with activity and worry free living not being a burden to our children. I want to thank the Crew at Hope Bariatric(s) including Dr. Felix, Cindy, Diane, Denise and Sherry for their support, guidance, thoughtfulness, professionalism and caring in this past year. I started at 394 lbs BMI of 56.1 to 215 lbs BMI of 29.8 in just over 18 months. My only regret is that it took me too long to get over my own self-pride and apprehensions over whether or not this was the right choice. One year to the day after my surgery, I know now that it was the right choice and I know that this team has helped me through my process. Again thank you and if I can be of any help to you in the future please do not hesitate to call.

- Joe