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Patient Education

Hernia

  

Gallstones Laparoscopic Cholecystectomy

  

Gastrointestinal Endoscopy

  

Advantages of Laparoscopic Surgery

  

Breast Diseases

  

Day Care Surgeries

  

Bariatric (Obesity) Surgery

  

Cancer Surgeries

  

Piles

  

Cataract

  

Laparoscopic Treatment for Uterine & Fibroids

  

 

     - Myomectomy
     - Hysterectomy

  

Laparoscopic Appendicectomy

  

Laparoscopic Ovarian Cyst excision

  

Laparoscopic Fundoplication for Hiatus Hernia

  

Upper GI Endoscopy

  

 

     - PEG

  

Laparoscopic Varicocoelectomy

  

 

Body Mass Index
 
 
  
 

Obesity Surgery

Is it right for you?

  

What is BMI?

  

read more... 

About Obesity

  

 

Page 1 | 2 | 3 | 4 | 5

Patient history and information

Patient Name

:

Age

:

Weight

:

Kgs.

Height

:

Cms.

Address 1

:

Address 2

:

City

:

State

:

Country

:

Pin

:

E-mail

:

Phone Number

:

 

Mobile Number

:

Diabetes detected in

:

Me

  

 

Mother

  

Father

  

 

Brothers

  

Sisters

  

 

Children

  

Medicines used for Diabetes in 1st 5 years

:

What medicines are you having presently

:

Dosage

:

Are you on insulin

:

Yes

  

No

Associated Medical Problems :

Hypertension (High Blood Pressure)

:

Yes

  

No

Kidney problems

:

Yes

  

No

Eye problems

:

Yes

  

No

Leg tingling/ non-healing leg ulcer

:

Yes

  

No

Cardiac problem

:

Yes

  

No

Thyroid problem

:

Yes

  

No

High Uric Acid

:

Yes

  

No

High Cholesterol or Triglyceride

:

Yes

  

No

TB

:

Yes

  

No

Asthma

:

Yes

  

No

Paralysis

:

Yes

  

No

Liver problems / Jaundice

:

Yes

  

No

Problem with Erection

:

Yes

  

No

Habits

:

Smoking

  

since

 

quantity

Alcohol

 

since

 

quantity

Tobacco

 

since

 

quantity

Any previous abdominal operations ?

:

Yes

  

No

Diet Control

:

Yes

  

No

Exercise

:

Yes

  

No

Why do you want  to undergo operation for diabetes ?

:

What do you expect after surgery ?

:


 
   

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