Health Questionnaire

* The information you provide will help us to propose the best treatment for you, for which we ask you to respond with care and sincerity.

Identification File

Personal History

Have you been diagnosed with hepatitis?

Are you allergic to latex?

Allergic to any medicine or food?

Indicate the medications you currently use, the frequency with which you use it, the amount and the date you started using it

Indicate the illness you suffer from, since when you have it and what treatment you are taking

Indicate if any surgery has been done, the date and reason

Have you had any surgery for weight control?

Have you suffered a heart attack?


Have you been diagnosed with diverticulitis?

Do you have a history of ulcers?

Have you been diagnosed with ulcerative colitis?

Do you suffer from indigestion or reflux?

Have you had any Anti-Reflux surgery?

Diabetic History

Additional Information

Indicate any additional information that you think is important in the evaluation of your health status

Ismael Cabrera, MD

Stop Obesity Bariatric Surgery

Stop Obesity Bariatric Surgery helps patients all over the world achieve their weight loss goals. Dr. Ismael Cabrera is a double board-certified bariatric surgeon who delivers quality results and has a complication rate of just 0.1%. He is regarded for his meticulous nature and the care, dedication, and personalized attention he devotes to each patient. Dr. Cabrera is affiliated with the:

  • Mexican Council of General Surgeons
  • Mexico College of Bariatric and Metabolic Surgeons
  • Member or the American Society for Metabolic and Bariatric Surgery
  • Máster Surgeon Metabolic and Bariatric Surgery

Are you ready to live the healthier life bariatric surgery can provide? Request a consultation with our form or call our Tijuana office at (609) 532-0090. If you are calling from Mexico, call +52 (664) 748-0407

Contact Us Today

Rate, Review & Explore

Social Accounts Sprite