Do you have any questions?

Handy: +90 531 421 40 02

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Last Name & First Name:

Landline phone & mobile number (if possible with country code):

Your age, height & weight: Do you know your BMI, we absolutely need it.

Allergies :

Pre-existing conditions:

Do you have high blood pressure or heart problems?

Do you have diabetes, if you take insulin or tablets, or both?

Do you have a risk of thrombosis or do you like eating sweets?

How many cigarettes do you smoke a day?

Shall we call you back? When are you best to reach?

When should the treatment take place?

What should be done? Stomach reduction, gastric bypass, gastric balloon

Have you had a gastric balloon, gastric folds, or stomach stapling?

Do you take medication on a regular basis ? If yes, which:

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BMI calculator