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2337 W 76 St, Hialeah Fl 33016
(305)-549-5348
(786)-227-2966
infoweightloss@energymedicalcenter.com

4995 Nw 72nd Ave suite 102, Miami FL 33166
(786)-360-3584
(786)-227-2966
infoweightloss@energymedicalcenter.com

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Do you have health insurance? *YesNo

If you have health insurance, which one do you have? *ObamacareMedicaidComercial

Obamacare *OscarAetna CVsAmbetterMolinaAmeriHealth CaritasUnited

Medicaid *SunshineMolina⁠Aetna Better HealthUnited

Comercial *CignaAetna

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Sex assigned at birthFemaleMale

Pounds

Feet

Inches

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convert-pies

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BMI

BMI Range

BMI

Under 18.5

18.5 – 24.9

25.0 – 29.9

30.0 – 34.9

35.0 – 39.9

40.0 or more

Weight Level

Underweight

Normal weight

Overweight

Obesity grade I

Obesity grade II

Obesity grade III

Low Weight

BMI Range

BMI

Under 18.5

18.5 – 24.9

25.0 – 29.9

30.0 – 34.9

35.0 – 39.9

40.0 or more

Weight Level

Underweight

Normal weight

Overweight

Obesity grade I

Obesity grade II

Obesity grade III

Normal Weight

BMI Range

BMI

Under 18.5

18.5 – 24.9

25.0 – 29.9

30.0 – 34.9

35.0 – 39.9

40.0 or more

Weight Level

Underweight

Normal weight

Overweight

Obesity grade I

Obesity grade II

Obesity grade III

Overweight

BMI Range

BMI

Under 18.5

18.5 – 24.9

35.0 – 39.9

30.0 – 34.9

35.0 – 39.9

40.0 or more

Weight Level

Underweight

Normal weight

Overweight

Obesity grade I

Obesity grade II

Obesity grade III

Obesidad Grado I

BMI Range

BMI

Under 18.5

18.5 – 24.9

35.0 – 39.9

30.0 – 34.9

35.0 – 39.9

40.0 or more

Weight Level

Underweight

Normal weight

Overweight

Obesity grade I

Obesity grade II

Obesity grade III

Obesidad Grado II

BMI Range

BMI

Under 18.5

18.5 – 24.9

35.0 – 39.9

30.0 – 34.9

35.0 – 39.9

40.0 or more

Weight Level

Underweight

Normal weight

Overweight

Obesity grade I

Obesity grade II

Obesity grade III

Obesity Grade III

Have you been diagnosed with any of the following conditions?High PressureType 2 diabetesHigh CholesterolPulmonary conditionNoneOther

How much do you exercise?3-4 days a week2-3 days a weekVery littleNeverOther

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