Gastric Bypass Pre-Surgical Psychological Evaluation Intake Form 2026

1. Start by clicking ‘Get Form’ to open the Gastric Bypass Pre-Surgical Psychological Evaluation Intake Form in our editor.
2. Begin with the 'Personal Data' section. Fill in your name, address, email, date of birth, and contact numbers. Ensure accuracy as this information is crucial for your evaluation.
3. Move on to 'Main Concerns'. List your reasons for seeking gastric bypass surgery and rate their importance using the provided scale from 1 to 10.
4. Complete the 'Health Care Providers' section by listing your primary care physician and any specialists you have seen. This helps provide a comprehensive view of your health history.
5. In the 'Weight History' section, provide details about your weight journey including current weight, lowest weight after age 25, and any family history of obesity.
6. Fill out the 'Dieting History' and 'Nutrition and Food History' sections thoroughly. Include past dieting programs and eating habits to give insight into your relationship with food.
7. Lastly, address the 'Exercise Status' and 'Goals for Bariatric Surgery'. Be honest about your exercise routine and outline your hopes and fears regarding the surgery.

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