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Are You a Candidate for Weight Loss Surgery?
Take our 60 Second Assessment to Find Out.
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Boost Bariatrics
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I am...
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Do you struggle to maintain a healthy weight using only diet and exercise?
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No
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Do you suffer from any of these common health issues?
Select all that apply. Then select "Next."
Heartburn / Acid Reflux
High Blood Pressure
Sleep Apnea
Diabetes
Joint/Bone Issues
Depression
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Hidden field: if heartburn is selected, pass in value of 1
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Hidden field: Pass in heartburn if value is 1 from previous question
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Hidden: Convert Height to Total Inches
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Hidden: BMI Calculator
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What is your height and weight?
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Enter your height and weight below.
Weight (lbs)
Height (ft)
Height (in)
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What is your biggest challenge or question right now?
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Select one from below.
Can I afford it?
Is surgery right for me?
Will I keep the weight off long-term?
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Which payment option describes you best?
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Select one from below.
Self-Pay / Financing
Private Insurance
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18
Have you decided which treatment is right for you?
Select one from below. If you are not sure yet, that is perfectly fine. Just select "Not Sure Yet"
Not Sure Yet
Gastric Bypass
Gastric Sleeve
Duodenal Switch
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19
Where are you in your Weight Loss Surgery decision process?
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Step 1. Researching
Step 2. Evaluating Treatments
Step 3. Choosing my Doctor
Step 4. Ready to Book a Consult
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Please agree to the message below so we can send your results.
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I agree to receive text messages regarding weight loss treatments from Florida Coast at the phone number provided above. Message and data rates may apply. The frequency of messages may vary. Reply STOP to opt out. Text HELP for help.
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Thanks! Where can we send your results?
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Enter your information below to receive your Personalized Results. You will also receive an Email Course about your weight loss options from the team at Florida Coast Weight Loss. We keep your information safe and private🔒. This Assessment is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. By providing your cell phone number you agree to receive calls and texts to that number from Florida Coast Weight Loss.
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Email
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Phone
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First Name
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Last Name
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Date of Submission
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