Free Bariatric Surgery Psychological Evaluation Template
Bariatric Surgery Psychological Evaluation
[Your Company Name]
Patient Information:
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Name: |
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Age: |
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Gender: |
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Date of Evaluation: |
Date: [Date]
Introduction
This Bariatric Surgery Psychological Evaluation helps determine an individual's psychological readiness for the surgery. It considers both physical and psychological aspects to ensure optimal patient outcomes, aiming to identify psychological hurdles that may affect surgical success and recovery.
Background
Bariatric surgery, suggested for severely obese individuals failing traditional weight loss methods, has proven physical and vital psychological benefits. Addressing related psychological issues, like depression or anxiety, pre-surgery predicts long-term success and well-being.
Instructions:
Please answer each question honestly and to the best of your ability. Your responses will remain confidential and will only be used to assess your suitability for bariatric surgery. If you have any concerns or questions about the evaluation, please feel free to discuss them with your healthcare provider.
Preoperative Assessment
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Criteria |
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1. Have you previously attempted to lose weight through diet and exercise? |
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2. Do you have a history of mental health disorders such as depression or anxiety? |
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3. Are you currently receiving treatment or therapy for any psychological issues? |
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4. Have you experienced significant life stressors or traumatic events in the past? |
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5. Do you have a support system in place to help you through the bariatric surgery process? |
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6. Are you aware of the potential risks and complications associated with bariatric surgery? |
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7. Are you committed to making necessary lifestyle changes post-surgery, including dietary and exercise habits? |
Comment/Feedback
Kindly share your feedback on the bariatric surgery psychological evaluation process. Your insights are essential to enhance our service. Thanks for your help.
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Comments and Feedback |
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