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<p>Your results will be used by your doctor to help focus your education during your visit. This quiz is not used for screening purposes or to disqualify people from surgery. Your information will be kept confidential and only used by your surgeon&rsquo;s office for registration purposes.</p><p><span style=\'font-size: 24px;\'><strong>Part 1: Questions for Video #1</strong></span></p><div class=\'form-group\'><label  class=\'control-label  \'>1.	Which of the following is one of the MOST effective way to lose weight (and keep it off) for a person who is at least 80+ pounds overweight?<span class=\'fb-required\'>*</span></label><div class=\'Chkbx\'><div><fieldset class=\'RadioGroup\'><div class=\'separate\'><input type=\'radio\' value=\'a. The Atkins diet only.\' required data-msg-required=\'This field is required.\' name=\'checkbox1\' id=\'FormField1_130da6ea-35b6-4192-93c2-784107f3e22e_1\' class=\'right\' data-export-label=\'Q1\' ><label for=\'FormField1_130da6ea-35b6-4192-93c2-784107f3e22e_1\'>a. The Atkins diet only.</label></div><div class=\'separate\'><input type=\'radio\' value=\'b. Exercising for 3 hours per day.\' required data-msg-required=\'This field is required.\' name=\'checkbox1\' id=\'FormField1_130da6ea-35b6-4192-93c2-784107f3e22e_2\' class=\'right\' data-export-label=\'Q1\' ><label for=\'FormField1_130da6ea-35b6-4192-93c2-784107f3e22e_2\'>b. Exercising for 3 hours per day.</label></div><div class=\'separate\'><input type=\'radio\' value=\'c. Bariatric surgery along with lifestyle changes.\' required data-msg-required=\'This field is required.\' name=\'checkbox1\' id=\'FormField1_130da6ea-35b6-4192-93c2-784107f3e22e_3\' class=\'right\' data-export-label=\'Q1\' ><label for=\'FormField1_130da6ea-35b6-4192-93c2-784107f3e22e_3\'>c. Bariatric surgery along with lifestyle changes.</label></div><div class=\'separate\'><input type=\'radio\' value=\'d. Medication with diet and exercise.\' required data-msg-required=\'This field is required.\' name=\'checkbox1\' id=\'FormField1_130da6ea-35b6-4192-93c2-784107f3e22e_4\' class=\'right\' data-export-label=\'Q1\' ><label for=\'FormField1_130da6ea-35b6-4192-93c2-784107f3e22e_4\'>d. Medication with diet and exercise.</label></div></fieldset></div></div></div><div class=\'form-group\'><label  class=\'control-label  \'>2. Which patient qualifies for bariatric surgery?<span class=\'fb-required\'>*</span></label><div class=\'Chkbx\'><div><fieldset class=\'RadioGroup\'><div class=\'separate\'><input type=\'radio\' value=\'a. A person with a body mass index (BMI) of 24 and diabetes.\' required data-msg-required=\'This field is required.\' name=\'checkbox2\' id=\'FormField2_130da6ea-35b6-4192-93c2-784107f3e22e_1\' class=\'right\' data-export-label=\'Q2\' ><label for=\'FormField2_130da6ea-35b6-4192-93c2-784107f3e22e_1\'>a. A person with a body mass index (BMI) of 24 and diabetes.</label></div><div class=\'separate\'><input type=\'radio\' value=\'b. A person with BMI between 35-40 with obesity-related health issues\' required data-msg-required=\'This field is required.\' name=\'checkbox2\' id=\'FormField2_130da6ea-35b6-4192-93c2-784107f3e22e_2\' class=\'right\' data-export-label=\'Q2\' ><label for=\'FormField2_130da6ea-35b6-4192-93c2-784107f3e22e_2\'>b. A person with BMI between 35-40 with obesity-related health issues</label></div><div class=\'separate\'><input type=\'radio\' value=\'c. A person with a BMI 34 with no obesity-related health issues.\' required data-msg-required=\'This field is required.\' name=\'checkbox2\' id=\'FormField2_130da6ea-35b6-4192-93c2-784107f3e22e_3\' class=\'right\' data-export-label=\'Q2\' ><label for=\'FormField2_130da6ea-35b6-4192-93c2-784107f3e22e_3\'>c. A person with a BMI 34 with no obesity-related health issues.</label></div><div class=\'separate\'><input type=\'radio\' value=\'d. A person who has never tried to lose weight and wants a “quick fix” with surgery.\' required data-msg-required=\'This field is required.\' name=\'checkbox2\' id=\'FormField2_130da6ea-35b6-4192-93c2-784107f3e22e_4\' class=\'right\' data-export-label=\'Q2\' ><label for=\'FormField2_130da6ea-35b6-4192-93c2-784107f3e22e_4\'>d. A person who has never tried to lose weight and wants a “quick fix” with surgery.</label></div></fieldset></div></div></div><div class=\'form-group\'><label  class=\'control-label  \'>3.	TRUE or FALSE: After bariatric surgery, a person should expect to lose all of their excess body weight within 2 months?<span class=\'fb-required\'>*</span></label><div class=\'Chkbx\'><div><fieldset class=\'RadioGroup\'><div class=\'separate\'><input type=\'radio\' value=\'a. True\' required data-msg-required=\'This field is required.\' name=\'checkbox3\' id=\'FormField3_130da6ea-35b6-4192-93c2-784107f3e22e_1\' class=\'right\' data-export-label=\'Q3\' ><label for=\'FormField3_130da6ea-35b6-4192-93c2-784107f3e22e_1\'>a. True</label></div><div class=\'separate\'><input type=\'radio\' value=\'b. False\' required data-msg-required=\'This field is required.\' name=\'checkbox3\' id=\'FormField3_130da6ea-35b6-4192-93c2-784107f3e22e_2\' class=\'right\' data-export-label=\'Q3\' ><label for=\'FormField3_130da6ea-35b6-4192-93c2-784107f3e22e_2\'>b. False</label></div></fieldset></div></div></div><div class=\'form-group\'><label  class=\'control-label  \'>4. TRUE or FALSE: Bariatric surgery works best when a person makes a lifelong commitment of lifestyle changes.<span class=\'fb-required\'>*</span></label><div class=\'Chkbx\'><div><fieldset class=\'RadioGroup\'><div class=\'separate\'><input type=\'radio\' value=\'a. True\' required data-msg-required=\'This field is required.\' name=\'checkbox4\' id=\'FormField4_130da6ea-35b6-4192-93c2-784107f3e22e_1\' class=\'right\' data-export-label=\'Q4\' ><label for=\'FormField4_130da6ea-35b6-4192-93c2-784107f3e22e_1\'>a. True</label></div><div class=\'separate\'><input type=\'radio\' value=\'b. False\' required data-msg-required=\'This field is required.\' name=\'checkbox4\' id=\'FormField4_130da6ea-35b6-4192-93c2-784107f3e22e_2\' class=\'right\' data-export-label=\'Q4\' ><label for=\'FormField4_130da6ea-35b6-4192-93c2-784107f3e22e_2\'>b. False</label></div></fieldset></div></div></div><div class=\'form-group\'><label  class=\'control-label  \'>5.	The following procedures are accepted options for weight loss surgery; EXCEPT:<span class=\'fb-required\'>*</span></label><div class=\'Chkbx\'><div><fieldset class=\'RadioGroup\'><div class=\'separate\'><input type=\'radio\' value=\'a. Laparoscopic adjustable gastric band (Lap BAND).\' required data-msg-required=\'This field is required.\' name=\'checkbox5\' id=\'FormField5_130da6ea-35b6-4192-93c2-784107f3e22e_1\' class=\'right\' data-export-label=\'Q5\' ><label for=\'FormField5_130da6ea-35b6-4192-93c2-784107f3e22e_1\'>a. Laparoscopic adjustable gastric band (Lap BAND).</label></div><div class=\'separate\'><input type=\'radio\' value=\'b. Laparoscopic Roux-en Y GASTRIC BYPASS.\' required data-msg-required=\'This field is required.\' name=\'checkbox5\' id=\'FormField5_130da6ea-35b6-4192-93c2-784107f3e22e_2\' class=\'right\' data-export-label=\'Q5\' ><label for=\'FormField5_130da6ea-35b6-4192-93c2-784107f3e22e_2\'>b. Laparoscopic Roux-en Y GASTRIC BYPASS.</label></div><div class=\'separate\'><input type=\'radio\' value=\'c. Laparoscopic Vertical SLEEVE GASTRECTOMY.\' required data-msg-required=\'This field is required.\' name=\'checkbox5\' id=\'FormField5_130da6ea-35b6-4192-93c2-784107f3e22e_3\' class=\'right\' data-export-label=\'Q5\' ><label for=\'FormField5_130da6ea-35b6-4192-93c2-784107f3e22e_3\'>c. Laparoscopic Vertical SLEEVE GASTRECTOMY.</label></div><div class=\'separate\'><input type=\'radio\' value=\'d. Liposuction\' required data-msg-required=\'This field is required.\' name=\'checkbox5\' id=\'FormField5_130da6ea-35b6-4192-93c2-784107f3e22e_4\' class=\'right\' data-export-label=\'Q5\' ><label for=\'FormField5_130da6ea-35b6-4192-93c2-784107f3e22e_4\'>d. Liposuction</label></div></fieldset></div></div></div><p><span style=\'font-size: 24px;\'><strong>Part 2: Questions for Video #2</strong></span></p><div class=\'form-group\'><label  class=\'control-label  \'>6. Which of the following increases your risks for developing blood clots after bariatric surgery?<span class=\'fb-required\'>*</span></label><div class=\'Chkbx\'><div><fieldset class=\'RadioGroup\'><div class=\'separate\'><input type=\'radio\' value=\'a. Smoking and estrogen-based birth control\' required data-msg-required=\'This field is required.\' name=\'checkbox7\' id=\'FormField7_130da6ea-35b6-4192-93c2-784107f3e22e_1\' class=\'right\' data-export-label=\'Q6\' ><label for=\'FormField7_130da6ea-35b6-4192-93c2-784107f3e22e_1\'>a. Smoking and estrogen-based birth control</label></div><div class=\'separate\'><input type=\'radio\' value=\'b. Vitamins\' required data-msg-required=\'This field is required.\' name=\'checkbox7\' id=\'FormField7_130da6ea-35b6-4192-93c2-784107f3e22e_2\' class=\'right\' data-export-label=\'Q6\' ><label for=\'FormField7_130da6ea-35b6-4192-93c2-784107f3e22e_2\'>b. Vitamins</label></div><div class=\'separate\'><input type=\'radio\' value=\'c. Poor diet\' required data-msg-required=\'This field is required.\' name=\'checkbox7\' id=\'FormField7_130da6ea-35b6-4192-93c2-784107f3e22e_3\' class=\'right\' data-export-label=\'Q6\' ><label for=\'FormField7_130da6ea-35b6-4192-93c2-784107f3e22e_3\'>c. Poor diet</label></div><div class=\'separate\'><input type=\'radio\' value=\'d. Exercise\' required data-msg-required=\'This field is required.\' name=\'checkbox7\' id=\'FormField7_130da6ea-35b6-4192-93c2-784107f3e22e_4\' class=\'right\' data-export-label=\'Q6\' ><label for=\'FormField7_130da6ea-35b6-4192-93c2-784107f3e22e_4\'>d. Exercise</label></div></fieldset></div></div></div><div class=\'form-group\'><label  class=\'control-label  \'>7. TRUE or FALSE: It is essential that you take vitamin supplements after bariatric surgery.<span class=\'fb-required\'>*</span></label><div class=\'Chkbx\'><div><fieldset class=\'RadioGroup\'><div class=\'flow\'><input type=\'radio\' value=\'a. True\' required data-msg-required=\'This field is required.\' name=\'checkbox8\' id=\'FormField8_130da6ea-35b6-4192-93c2-784107f3e22e_1\' class=\'right\' data-export-label=\'Q7\' ><label for=\'FormField8_130da6ea-35b6-4192-93c2-784107f3e22e_1\'>a. True</label></div><div class=\'flow\'><input type=\'radio\' value=\'b. False\' required data-msg-required=\'This field is required.\' name=\'checkbox8\' id=\'FormField8_130da6ea-35b6-4192-93c2-784107f3e22e_2\' class=\'right\' data-export-label=\'Q7\' ><label for=\'FormField8_130da6ea-35b6-4192-93c2-784107f3e22e_2\'>b. False</label></div></fieldset></div></div></div><div class=\'form-group\'><label  class=\'control-label  \'>8. TRUE or FALSE: The risk of death is very low in bariatric surgery, about 1 in 1,000.<span class=\'fb-required\'>*</span></label><div class=\'Chkbx\'><div><fieldset class=\'RadioGroup\'><div class=\'separate\'><input type=\'radio\' value=\'a. True\' required data-msg-required=\'This field is required.\' name=\'checkbox9\' id=\'FormField9_130da6ea-35b6-4192-93c2-784107f3e22e_1\' class=\'right\' data-export-label=\'Q8\' ><label for=\'FormField9_130da6ea-35b6-4192-93c2-784107f3e22e_1\'>a. True</label></div><div class=\'separate\'><input type=\'radio\' value=\'b. False\' required data-msg-required=\'This field is required.\' name=\'checkbox9\' id=\'FormField9_130da6ea-35b6-4192-93c2-784107f3e22e_2\' class=\'right\' data-export-label=\'Q8\' ><label for=\'FormField9_130da6ea-35b6-4192-93c2-784107f3e22e_2\'>b. False</label></div></fieldset></div></div></div><div class=\'form-group\'><label  class=\'control-label  \'>9. Which is not a potential complication of bariatric surgery?<span class=\'fb-required\'>*</span></label><div class=\'Chkbx\'><div><fieldset class=\'RadioGroup\'><div class=\'separate\'><input type=\'radio\' value=\'a. Bleeding\' required data-msg-required=\'This field is required.\' name=\'checkbox10\' id=\'FormField10_130da6ea-35b6-4192-93c2-784107f3e22e_1\' class=\'right\' data-export-label=\'Q9\' ><label for=\'FormField10_130da6ea-35b6-4192-93c2-784107f3e22e_1\'>a. Bleeding</label></div><div class=\'separate\'><input type=\'radio\' value=\'b. Infection\' required data-msg-required=\'This field is required.\' name=\'checkbox10\' id=\'FormField10_130da6ea-35b6-4192-93c2-784107f3e22e_2\' class=\'right\' data-export-label=\'Q9\' ><label for=\'FormField10_130da6ea-35b6-4192-93c2-784107f3e22e_2\'>b. Infection</label></div><div class=\'separate\'><input type=\'radio\' value=\'c. Dehydration\' required data-msg-required=\'This field is required.\' name=\'checkbox10\' id=\'FormField10_130da6ea-35b6-4192-93c2-784107f3e22e_3\' class=\'right\' data-export-label=\'Q9\' ><label for=\'FormField10_130da6ea-35b6-4192-93c2-784107f3e22e_3\'>c. Dehydration</label></div><div class=\'separate\'><input type=\'radio\' value=\'d. Weight loss\' required data-msg-required=\'This field is required.\' name=\'checkbox10\' id=\'FormField10_130da6ea-35b6-4192-93c2-784107f3e22e_4\' class=\'right\' data-export-label=\'Q9\' ><label for=\'FormField10_130da6ea-35b6-4192-93c2-784107f3e22e_4\'>d. Weight loss</label></div></fieldset></div></div></div><div class=\'form-group\'><label  class=\'control-label  \'>10. Which is not a cause of dumping syndrome?<span class=\'fb-required\'>*</span></label><div class=\'Chkbx\'><div><fieldset class=\'RadioGroup\'><div class=\'separate\'><input type=\'radio\' value=\'a. Eating too quickly\' required data-msg-required=\'This field is required.\' name=\'checkbox11\' id=\'FormField11_130da6ea-35b6-4192-93c2-784107f3e22e_1\' class=\'right\' data-export-label=\'Q10\' ><label for=\'FormField11_130da6ea-35b6-4192-93c2-784107f3e22e_1\'>a. Eating too quickly</label></div><div class=\'separate\'><input type=\'radio\' value=\'b. Eating sugary foods\' required data-msg-required=\'This field is required.\' name=\'checkbox11\' id=\'FormField11_130da6ea-35b6-4192-93c2-784107f3e22e_2\' class=\'right\' data-export-label=\'Q10\' ><label for=\'FormField11_130da6ea-35b6-4192-93c2-784107f3e22e_2\'>b. Eating sugary foods</label></div><div class=\'separate\'><input type=\'radio\' value=\'c. Chewing your food well and eating slowly\' required data-msg-required=\'This field is required.\' name=\'checkbox11\' id=\'FormField11_130da6ea-35b6-4192-93c2-784107f3e22e_3\' class=\'right\' data-export-label=\'Q10\' ><label for=\'FormField11_130da6ea-35b6-4192-93c2-784107f3e22e_3\'>c. Chewing your food well and eating slowly</label></div><div class=\'separate\'><input type=\'radio\' value=\'d. Eating solid food and drinking liquids together\' required data-msg-required=\'This field is required.\' name=\'checkbox11\' id=\'FormField11_130da6ea-35b6-4192-93c2-784107f3e22e_4\' class=\'right\' data-export-label=\'Q10\' ><label for=\'FormField11_130da6ea-35b6-4192-93c2-784107f3e22e_4\'>d. Eating solid food and drinking liquids together</label></div></fieldset></div></div></div><p><span style=\'font-size: 30px;\'><strong>About Yourself</strong></span></p><div class=\'form-group\'><label for=\'FormField16_130da6ea-35b6-4192-93c2-784107f3e22e\' class=\'control-label  \'>First and Last Name<span class=\'fb-required\'>*</span></label><div>\
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