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Table
of Contents - Sample Excerpts
Chapter
18: Personal Medical Log
THIS INITIAL INFORMATION CAN HELP YOU GO THROUGH YOUR INITIAL CONSULTATION AND
KEEP TRACK OF YOUR MEDICAL HISTORY.
PERSONAL
INFORMATION
NAME___________________________________
DATE________________
DATE OF BIRTH_______________ AGE_____ GENDER ? M ? F
E-MAIL Address________________________________
How long have you been considering weight loss surgery?____________________
Have you done any research regarding weight loss Surgery? ? Yes ? No
If yes, what type?___________________________________________________
How did you hear about this program?__________________________________
Do you have a friend or family member who has had weight
loss surgery? ? Yes ? No If yes, who?_____________________________
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