Virtual consultation

Customized preliminary study

Complete your Obesity Medical History and we will make a preliminary therapeutic recommendation.

Due to operational problems we cannot attend to mail from outside the European Community. If this is your case and you are really interested, please call us at 699 57 73 50

General medical history

If you have any of these diseases, please check the box

  • Diabetes (year of diagnosis): :
  • High blood pressure
  • High cholesterol or triglycerides
  • High uric acid
  • Heart or lung disease (specify) :
  • Thyroid function problems
  • Intense fatigue when climbing stairs
  • Sleep Apnea
  • He snores (grade 1-5):
  • Easy daytime sleep
  • Acid reflux or food in the mouth
  • Heavy or slow digestions
  • Stomachaches or similar
  • Large varicose veins in the legs
  • Ankle swelling
  • Constipation Important
  • Irregular rules or absence
  • Migraine headaches
  • Frequent lower back pain or sciatica
  • Ankle, knee or hip problems? (specify):
  • Excessive, chronic depression or sadness

(Pesar 15 kg más que la altura.Ejemplo: Si peso 85 kg y mido 170cm)(Indicar nº de familiares)








type of operation/year of the same/type of anesthesia (local, or general):

  • For diabetes, tablets
  • For Diabetes Insulin
  • For high voltage
  • To lower cholesterol or triglycerides
  • To decrease the Uric acid
  • Thyroid hormones
  • Contraceptives
  • For depression or anxiety
  • To sleep
  • Other drugs:

History of your obesity

  • Quitting smoking
  • Pregnancy(s)
  • Change to a more sedentary life
  • Suffering from a disease
  • Taking drugs
  • Emotional causes

Analysis of your dietary profile

  • Breakfast
  • Lunch
  • Food
  • Snack
  • Dinner
  • Before you eat
  • Before dinner

  • In the morning
  • In the afternoon

What is your style of cooking, salty, mild?   

Yes No
2-4 4-6 6-8
How would you describe yourself, mainly?
  • Large dining room
  • Picoteador/a
  • Dining room for sweets
Do you usually drink in large quantities? What and how much per day

Análisis de su perfil psicológico


Yes No


Yes No


Yes No


Personal information











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