Name   Gender   Male Female Address   Postcode   Town   Country   Date of birth   Marital Status   Home phone number   Mobile phone number   Email address   Height   Start weight   Current weight   Surgery type   Gastric Band Gastric Bypass Gastric Balloon Duodenal Snith VBG BPD Sleeve Revision Other, please state   Surgery Date   Do you have any medical conditions?   Yes No If yes, please state   Are you on medication?   Yes No If yes, please state   Do you have any food allergies?   Yes No If yes, please state   Are you taking any multi-vitamin/minerals?   Yes No Do you drink alcohol?   Yes No Have you seen a dietician before?   Yes No Do you engage in any physical activity?   Yes No Are you motivated to make changes to your lifestyle?   Yes No Are you interested in attending support groups?   Yes No