Contact

Contact form:

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Last Name & First Name:

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

Your age, height & weight:

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?

Message:

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