Western Wake Counseling & Psychological Services, PLLC

Rating Scale
1 = Not at all 5 = Completely

How satisfied are you with how your life has changed since surgery (*)
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Have you developed new strategies for coping with high-risk food situations? (*)
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Are you able to identify and express your emotions without wanting to turn (or turning back) to food? (*)
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Do you wish your life had changed the way you imagined it would before you had the surgery? (*)
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Have you re-gained weight lost after surgery because old eating habits came back? (*)
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Do you feel that you have adequate support to assist you on this journey? (*)
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Have you developed an exercise routine that you enjoy and can maintain fairly consistently? (*)
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Are you still walking around feeling like you are obese despite losing a lot of weight? (*)
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Do you feel "safe" as you walk around in the world with your thinner body? (*)
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Have you found yourself turning to alcohol, prescription or recreational drugs, excessive shopping or other compulsive behaviors since your surgery? (*)
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Total Score:
40-50 You've made most of the changes you need for long-term weight loss. If you stay focused, you're likely to be a success story.

30-40 You have some problem areas or skills you haven't learned yet. Use your responses to identify areas you need to focus on in order to make changes. Joining a Transformations group or obtaining one of our other services can help prevent future problems.

Below 30 There are probably too many problem areas for you to correct on your own. The Transformations Programs are specifically designed to help you make the changes you need. Contact us to find out how.

When did you have surgery?

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What was your pre-surgery weight?

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What was your pre-surgery BMI?

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What is your current weight?

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What is your current BMI?

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Is there anything you wish you had known about WLS before proceeding with the operation?

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May we contact you to further discuss your experience with WLS?
If yes… please enter your email address below? We will not share your private information.
We will be sending out an email to our surgery patients for the last 6 months of 2010 with the link to the website to gather information about how they are doing now? This will be very valuable data…

Email Address

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