Section of General Surgery

Getting Started

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Instructions to complete your on-line Informational Session:

  1. Please watch the entire video in the "Get Started" section
  2. Next fill out the form below
  3. Finally contact our Call Center at 734-936-5738 to schedule your initial evaluations. Please allow 24-48 business hours for us to review your quiz and update our records.


1. Obesity is related to the following illnesses:
Diabetes
High Blood Pressure
Sleep Apnea
High Cholesterol
All Of The Above

2. Weight loss surgery is performed through small incisions that helps reduce pain and complications:
True
False

3. An ulcer can happen after gastric bypass surgery if you:
Smoke
Take nonsteroidal anti-inflammatory drugs (nsaids) such as motrin, advil, ibuprofen or aspirin.
All Of The Above
None Of The Above

4. Sleeve gastrectomy is a reversible procedure:
True
False

5. Who qualifies for weight loss surgery?
Body Mass Index (BMI) Over 40
Body Mass Index (BMI) over 35 + weight-related conditions such as diabetes or hypertension
Body Mass Index (BMI) under 30
A and B


* Last Name:      * First Name:

* Date of Birth (MM/DD/YYYY):

* Your Email:

* Your Phone Number:

Please provide your weight & height so we can calculate your Body Mass Index (BMI)

Weight:  lbs.

Height:  feet       inches


How much weight do you want to lose with bariatric surgery?  lbs

Which weight related illness is the most important health issue for you?

Have you had bariatric surgery in the past? If so which one?

Are you interested in participating in research?
Yes
No


 I verify that I am the patient, I have watched the video, and I have taken the quiz above.

Thank you for your interest in the Bariatric Surgery Program at the University of Michigan! Please allow 24-48 business hours for us to review your quiz and update our records. You may then contact our Call Center at 734-936-5738 to schedule your initial evaluations.

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