Questionnaire for New Bariatric Surgery Patients
Please download the form by right-clicking and choosing "Save Link As..." on this link:
Please note that you must open the file in Adobe Reader if you would like to fill out the form on your computer and save it.
Please complete this form and return it to us by doing one of the following:
- E-mailing it to us at firstname.lastname@example.org
- Faxing it to us at (626) 226-5827
- Bringing it with you to your appointment
If you have any difficulties filling out the form or any questions whatsoever, please call us at (626) 600-2094.