Qualification Assessment

The following interactive assessment can help determine if weight loss surgery is a good option for you. (Please note: If you’re under 18 years old, visit a pediatrician to see if you’re a candidate for bariatric surgery.)

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1. What is your name?*
2. What is your email?*
Address - Line 1* Address - Line 2 City* State* Zip Code*
3. Have you ever been or are you currently a patient of Virginia Mason Franciscan Health?*
4. Enter your height:*
5. Enter your weight:*
6. What is your Date of Birth?*
7. Do you have any of the following health conditions?








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