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New patient questionnaire

Welcome to your program! Before your first appointment, help Dr. Larocque get to know you: your weight, your health, your habits and your goals.

10 minto fill in the questionnaire
7 stepsshort and easy on a phone
Saveand finish later if you need to

🔒 Your answers are confidential. They are only used to prepare and provide your follow-up with Dr. Larocque.

Step 1 of 7 - You and your weight

Please enter a number from 12 to 110.
Date of birth
Sex
Program purchased(Required)
Preferred times for the first appointment
Appointment by

Questions? Email us at [email protected].