EmailMeForm
The Gastro-fit questionnaire
The importance of life after gastric band surgery.
Please fill out all the fields the best you can.
Gender
*
Male
Female
Age Group
*
18-24
25-29
30-34
35-44
45-49
50-60
61-65
66+
On a scale of 1-10, 10 being most committed, how dedicated do you think you would be in a post surgery rehabilitation programme?
*
1
2
3
4
5
6
7
8
9
10
Research shows that exercise is an important intervention in reducing cardiac risk factors; on a scale of 1-10 how important do you think it is to exercise post surgery?
*
1
2
3
4
5
6
7
8
9
10
Would you be interested in participating in a sophisticated private after care package post gastric band surgery?
*
Yes
No
Would it be more appealing to have a more holistic approach to your aftercare using exercise specialists, clinical nutritionists and behavioural therapists?
*
Yes
No
On a scale of 1-10 how important do you think it is to have these key people in place to aid in promoting independence and a healthier and disease free lifestyle?
Psychologist
*
Please select
1
2
3
4
5
6
7
8
9
10
Clinical Dietician
*
Please select
1
2
3
4
5
6
7
8
9
10
Specialist Doctor
*
Please select
1
2
3
4
5
6
7
8
9
10
Exercise specialist
*
Please select
1
2
3
4
5
6
7
8
9
10
What type of environment would be most appealing as part of your post gastric band aftercare?
*
Mediterranean environment
UK based environment
Would you be interested in participating in a 12 month sophisticated post surgery intervention package which would include a 4 week tailored residential with a dedicated medical team on the Greek Island of Cyprus?
*
Yes
No
Provided that the evidence shows that exercise combined with a holistic approach is proven to maintain a healthy lifestyle and weight, would you be willing to invest up to £3,000 sterling pounds for a 4 week tailored residential in the Mediterranean followed by a 12 month subscription to a dedicated team of specialists offering constant advice and support on exercise diet and behavioural therapy?
*
Yes
No
Image Verification
Please enter the text from the image:
[
Refresh Image
] [
What's This?
]
Powered by
EMF
Online Form Builder
Report Abuse
