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Is ORBERA® Right For Me?
Learn more about the ORBERA® Weight Loss System to find out if it is the best weight loss option for you!
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I am a
*
Female
Male
My age is
*
21 or younger
22 - 30
30 - 40
40 - 50
50 - 65
65+
What is your current weight? (lbs)
*
What is your current BMI?
*
If you do not know your current BMI then click
here
to calculate it.
What is your height?
*
How much weight would you like to lose?
*
< 20 lbs.
20 - 30 lbs.
30 - 40 lbs.
40 - 50 lbs.
50 - 70 lbs.
70 - 100 lbs.
> 100 lbs.
NOTE: Patients tend to
lose 20-50 lbs
with ORBERA®. You may be a great candidate!
What weight loss options have you tried in the past?
*
Diets
Excercise
Commercial Diet (Weight Watchers, NutraSystem, etc.)
Physician Led Weight Loss
Weight Loss Medications
Have you ever had Bariatric Surgery (Sleeve, Bypass)?
No
Yes
How frustrated are you with your past weight loss efforts?
*
Not Frustrated
Somewhat Frustrated
Extremely Frustrated
Diets leaving you hungry?
- the ORBERA® Balloon beats the normal diet & excercise program by helping you
FEEL FULL
and
LOSE 3X THE WEIGHT!
No Incisions - No Surgery
What is your motivation for losing weight?
*
Appearance
Feeling Tired
Be More Active
Medical Conditions
Family / Children
Regained Weight
Are you willing to invest $150 - $200 / month to reach your weight loss goals?
*
Yes
Maybe
No
Name
*
Email
*
Phone
*
Zip Code
*
Would you like to receive more information about ORBERA®?
*
Yes
No
Sorry, but people who have had a surgery, such as lap band; gastric sleeve and bariatric surgery are not good candidates for this program.
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