Step 1 of 9

11%

I am...

I am...*

Male

Female

Where are you in your weight loss surgery decision process?

Where are you in your weight loss surgery decision process?*

Step 1: Researching

Step 2: Evaluation Treatments

Step 3: Choosing My Doctor

Step 4: Ready to Book a Consult

What excites you about the prospect of weight loss surgery?

Tell us your primary motivators for seeking the procedure. Select all that apply.

What excites you about the prospect of weight loss surgery?*

Manage or Improve Obesity-Related Health Issues

Improve My Body Image

Improve My Quality of Life

Avoid Future Risks or Health Issues

Help with Fertility / Future Family Planning

Other

What is your height and weight?

Height (ft’ in”)*

Weight (lbs.)*

What is your date of birth?

Date*

What is your current level of exercise?

What is your current level of exercise?*

Sedentary

Light Activity

Moderate

Vigorous Activity

Maximal Activity

It Varies

Let us know if you have any of the following medical issues, as this will further inform our recommendations for you.

Let us know if you have any of the following medical issues, as this will further inform our recommendations for you.*

Diabetes

Sleep Apnea

High Blood Pressure (Hypertension)

Heartburn

Acid Reflux

Joint/Bone Issues

Depression

Cardiovascular Disease

Pulmonary Disease

Active Substance Abuse (Alcohol or Drugs)

Family History of Cancer or Heart Disease

Other

None

Which payment option describes you best?

Which payment option describes you best?*

Self-Pay

Financing

Private Insurance

I am Not Sure

All done! Enter your information below to receive your Personalized Results.

You will also receive an Email Course about your weight loss options from the team at B+A Medical. We keep your information safe and private. This is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. By providing your contact information, you agree to receive calls and texts to your phone number from B+A Medical.

First Name*

Last Name*

Email*

Phone*

Name

This field is for validation purposes and should be left unchanged.

virtual bariatrics Tool