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Contact Surgery For Obesity Group

Name: (*)
e-mail: (*)
Country of Residence: (*)
City: (*)
Telephone:
Preferred Contact Times:
How Did You Find Us?: (*)
Comments:
Age:
Height:
Weight:
Associated diseases and stresses from obesity:
Previous treatments undergone for weight loss:
Have you been diagnosed with Diabetes?
Job Occupation:
How long have you been over-weight?
How quickly has your weight increased?
Have you had prior weight–loss surgery?

Dr. CARLOS FELIPE CHAUX MOSQUERA - Dr. MAURICIO FRANCO INFANTE - Dr. EDUARDO BOLAÑOS QUINTERO

Cirugía Para La Obesidad
Calle 83 # 16A - 44, Office 501. Bogotá, Colombia
PBX:  +57 (1) 7033872
contactenos@cirugiaparalaobesidad.com.co

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