Obesity surgery in Mexico at affordable prices. Weight loss surgery by Dr Jose A. Castañeda in Puerto Vallarta and Guadalajara.
Name:*
Brth Date:*
Phone:*
City:*
Address:*
State:*
Email:*
Profession:*
Other
DATE OF BIRTH
AGE
WEIGHT
HEIGHT
HIGHER WEIGHT
LOWER WEIGHT
WEIGHT LOSS ATTEMPTS:
WEIGTH LOSS PILLS:
HOURS OF SLEEP:
ANGST/ANXIETY:
SLEEPLESSNESS:
BREAKFAST
HOUR
WHERE?
SNACK
LUNCH
DINNER
DO YOU HAVE STABLISHED TIME FOR YOUR FOOD?
HOW MANY MEALS DO YOU MAKE DAILY?
DO YOU CONSUME HIGH FAT FOOD?
HOW MUCH WATER DO YOU DRINK DAILY?
DO YOU DRINK COFFEE OR TEA?
CUPS/DAY
REGULAR SUGAR OR SUGAR SUBSTITUTE:
DO YOU DRINK ALCOHOL?
TIMES A WEEK :
DO YOU PRACTICE ANY SPORT?
WHAT KIND OF SPORT?
TIMES A WEEK?
HOURS PER DAY?
Name *
Email *
Phone *
Country *
Surgery Required* Gastric BandGastrectomy SleeveRNY Gastric BypassMetabolic SurgeryDuodenal SwitchConversions
Need Health Insurance?* ---YesNo
Comments/Questions
Bariatric surgeon with 5000 procedures and 7 years experience
People from United States, Canada and UK have foun
Also known as, diabetes mellitus, diabetes is an a