Considering Surgery
Donna
The LP
Consult For Weight Loss Surgery Fax to: 902-425-3817
Capital District Health Authority
Date:
Patients Name:
DOB:
Address
Phone
GP (name/phone):
Risk Factors (Please check all that apply)
BMI>40 or 100lbs overweight
BMI>35 plus medical co-morbidities
Failure of medical management over a long period of time to control weight
HTN
Obesity related cardiomyopathy
Abnormal Glucose tolerance or Type 2 DM
Reflux esophagitis
Severe sleep apnea
Disabling arthritis, chronic low back pain, osteoarthritis, impending knee replacement surgery candidate
Breakdown of skin secondary to excess pannus with ongoing cellulitis or recurrent abcess
End stage obesity syndrome requiring hospitalization
Pseudotumor cerebri
Hyperphagic syndromes
Steatophepatitis and cirrhosis
Hyperlipidemias
Other syndromes ________________________________________
Age:
Weight:
Height:
BMI:
Supportive Information (social, psychological, lifestyle):
Referred for WLS in the past Y or N________ when_________
Physician Signature:
Contact info:
Leaky sleeve survivor!!! 2008/2009 ~ 5'7"~ 42F Bougie 
I tried to get it done in Halifax....but the 7 year wait list was too long for me to even consider.
So I went to Mexico, VSG done in April of this year.
Good Luck in your search.......and choice......PM me if you have any questions.
First you need to find the procedure that fits your needs. I does take some time to find out the different types of surgery that could work for you. Once you have done your homework then you need to talkit over with your famly Dr. There is a group of Docs doing the VGS in Halifax. There are Dr's doing the lap band in NB. If you do not want to wait the you can go out of province to have the surgery. If you select the band then you need to find someone to do the fills. Your family doc prob will not do them.
I had my band done in Toronto. I had to pay out of pocket. I do not regret my choice at all. I have also been trained by the clinic to do the adjustments.
So lokk for what will work for you good luck.
Laurie
