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Identification

Last name * :


First name * :


Sex * :


Age * :


Address :


Country * :


Phone * :


GSM :


E-mail * :


Weight * :
Kg

Size * :
Cm

Comorbidity

Diabete :
yes no

Diabetic heredity :
yes no

HTA :
yes no

Heart condition :
yes no

Smoker :
yes no

Type of intervention :


Type of food :


Are you taking treatment for a particular disease :


The list of medicines :


Extras

Accommodation : (hotel 3/4etoile devis gratuit)
yes no

With companion :
yes no

Special notes :


Would you like us to call you ?
yes no

What timezone ?


Recommended by :


The name of the doctor or patient :


How did you know Dr. Abittan :


 
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News

Workshop Naples


Le dr Abittan a été l’invité d’honneur à la 1 ère conférence méditerranéenne des chirurgiens experts de l’obésité MOSS!
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