Bariatric Surgery Pre-Operative Assessment
Patient Information
Full Name
Date of Birth
MRN
Anthropometrics
Height (cm)
Weight (kg)
BMI (kg/m²)
Medical History
Obesity-Related Comorbidities
Other Past Medical History
Medications & Allergies
Current Medications
Allergies
Surgical History
Previous Surgeries
Psychosocial Assessment
Psychosocial Factors (support system, mental health, etc.)
Pre-Operative Investigations
Relevant Investigations
Assessment Summary
Assessment & Plan