Complete Name (required)

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Your weight (required)

Obesity Related Problems. Only check if you have any of these conditions (required)
ObesityDiabetesHypertensionBone ProblemsDepressionSleep DisordersPhysical ConditionDigestive SystemHeart and Circulatory SystemRespiratory ProblemsCompulsive EatingIsolationGastro Esophageal RefluxHiatal HerniaSmokeDrink AlcoholUse DrugsUse of accessories such as: pacemakers, CPAP, removable dentures, etc.Drug allergyPreviuos abdominal surgeries?Are you in treatment?

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Preferred Surgery Date

Choose your kind of surgery (required)
Select OneSpatz BallonAllurion BallonGastric SleeveGastric BypassRevision Surgery

City of treatment or surgery? (required)
Select OneCancunMeridaMexico CityTijuanaLos Cabos

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