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Using the links below, download and fill out our patient forms before arriving for your appointment.

Weight Loss Consultation Patient Information

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Batash Endoscopic Weight Loss Center Manhattan

635 Madison Avenue, Suite 1400
New York, NY 10022

Phone: 718-830-0004

Batash Endoscopic Weight Loss Center Queens

97-12 63rd Drive
Rego Park, NY 11374

Phone: 718-830-0004

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Is Endoscopic Weight Loss Right For You?

Have you ever considered going on a diet to lose 10-15 pounds?
- Yes
- No
Have you ever lost a significant amount of weight only to gain it back?
- Yes
- No
Do you ever feel like you can’t control how much you eat?
- Yes
- No
Do you ever feel strong cravings for specific types of foods (e.g., sweet, spicy or fried foods)?
- Yes
- No
Do you ever feel like you spend too much time thinking about food, your weight, or what you have/haven’t eaten?
- Yes
- No
Do you consider yourself an emotional eater?
- Yes
- No
Have you ever engaged in food restriction or binge behaviors?
- Yes
- No
Do you consider certain foods or food groups as bad and restrict your intake of them?
- Yes
- No
Do you weigh yourself frequently?
- Yes
- No
Have you struggled with maintaining your goal weight?
- Yes
- No
Have you exercised excessively in order to lose weight?
- Yes
- No
Do you have any medical conditions that are the result of being overweight?
- Yes
- No
Do you have any medical conditions that are the result of being overweight?
- Yes
- No
Do you know your BMI (Body Mass Index)?
- Yes
- No