Bariatric Surgery Pre-Assessment Measurement Form
Patient Information
Full Name
Date of Birth
Gender
Male
Female
Other
Anthropometric Measurements
Height (cm)
Weight (kg)
BMI
Waist Circumference (cm)
Hip Circumference (cm)
Neck Circumference (cm)
Vital Signs
Blood Pressure (mmHg)
Heart Rate (bpm)
Respiratory Rate (/min)
Temperature (°C)
Medical History
Current Medications
Allergies
Other Notes