• + (216) 98 445 334
  • Ave Léopold Sengor, Imm. Selten Azure 4000 - Sousse
  • Mon. - Sat. : from 8:00 a.m. to 6:00 p.m.

Contact

Adress

Avenue Léopold Senghor. Seltène Azur building
6th floor, App 61

4000 Sousse, Tunisia

Business hours

Monday: 9:00 am – 7:00 pm
Tuesday: 9:00 am – 7:00 pm
Wednesday: 9:00 am – 7:00 pm
Thursday: 9:00 am – 7:00 pm
Friday: 9:00 am – 7:00 pm
Saturday: 11:00 am – 4:00 pm
Sunday: Closed

    Personal Details

    Civility

    General Information

    Height (cm)
    Weight (kg)






    Do you smoke?

    Medical History

    Allergies?
    Heart problems?

    Asthma?
    High blood pressure?

    Depression?
    Blood clot?

    Viral diseases?
    Anemia?

    Diabetes?
    Dyslipidemia?

    Other diseases:

    Surgical History

    Have you had surgeries before?

    What surgeries have you had?

    Weight History

    At what age did you start having weight issues?
    Have you tried diets?



    Lowest weight achieved after diet:
    Maximum weight reached in your life:






    Do you think your weight is stable?

    Eating Behavior

    How many meals do you eat per day?
    How many snacks do you have?






    Large quantities during meals:

    Feeling full quickly?

    Constant feeling of hunger

    Binge episodes / loss of control:

    Are there factors that cause you to eat when stressed?

    What do you usually eat when you feel hungry?

    Surgery

    What surgery are you interested in?

    Message:

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