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/She 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

(Weigh 15 kg more than the height, e.g.: If I weigh 85 kg and I am 170 cm tall) (Indicate number of family members)








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

  • Smoking cessation
  • Pregnancy/s
  • Change to a more sedentary lifestyle
  • Suffering from an illness
  • Taking medication
  • Emotional causes

Analysis of your dietary profile

  • Breakfast
  • Lunch
  • Lunch
  • Snack
  • Dinner
  • Before lunch
  • Before dinner

  • In the morning
  • In the afternoon

What is his style of cooking, savoury, soft?  

Yes No
2-4 4-6 6-8
How would you mainly describe yourself?
  • Big eater
  • Snacker
  • Sweet eater
Do you usually drink any beverages in large quantities? Which and how much per day

Analysis of your psychological profile


Yes No


Yes No


Yes No


Personal information











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