Sexual Health & Obesity

Age

Gender

Female

Male

What is your current weight?

Other

What is your current Height?

Other

Have you attended a pre surgical consult in anticipation of surgery?

yes

no

During your pre surgical evaluation did the health care professional inquire about your sexual health?

yes

no

How often have you visited a physicians office during the past year?

Weekly

Monthly

several times a month

several times a year

Would you say you are well informed about your sexual health?

Yes

No

Other

Are you planning to undergo bariatric(weight-loss)surgery?

yes

no

If you are planning on undergoing bariatric surgery what type do you plan on having done?

adjustable lap band

gastric sleeve

Vertical Banded Gastroplasty(VBG)

Fobi-pouch

Roux-en-Y Gastric Bypass

uncertain