PATIENT CONSENT TO PROCESSING PERSONAL DATA

    I hereby provide explicit and unambiguous consent to KCM Clinic S.A. for the processing of my data, as defined in the Act of April 27, 2016, regarding the protection of natural persons about the processing of personal data and the free movement of such data, and repealing Directive 95/46/EC GDPR (General Data Protection Regulation) Regulation (EU) 2016/679 of the European Parliament and the Council.

    YESNO

    Part A - Basic data

    Follow up 3m6m9m12m36m

    Sexfemalemale

    Surname

    Name

    Email

    Height in centimeters

    Weight in kilograms

    BMI

    How much weight did you lose after the procedure?

    What is your current weight?

    Have your eating habits changed after the treatment? yesno

    Other

    Has your social and family life changed positively after the surgery? yesno

    Has the treatment improved your health? yesno

    If applicable: Was it possible to reduce the medication for hypertension after the procedure? yesno

    Other

    If applicable: Was it possible to stop taking hypertension medications after the procedure? yesno

    Other

    If applicable: Was it possible to reduce the medication for diabetes II after the procedure? yesno

    Other

    If applicable: Was it possible to stop taking medication for diabetes II after the procedure? yesno

    Other

    Are there any new health problems? yesno

    Other

    Do you do more sports than before the surgery? yesno

    Other

    Do you think that the bariatric surgery was a good life decision? yesno

    Other

    Have you used the help of our support Facebook group? yesno

    Other

    Do you think our support Facebook group helped you in the period before and after the surgery? yesno

    Other

    Would you recommend bariatric surgery to your fellow obese patients? yesno

    Other