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We understand you want to have all the facts as you consider your decision to have weight loss surgery, Start Today!

Congratulations, you are one step closer to your goal!
Our mission is to provide the best medical care available. We urge you to review and research all the reasons for wanting to live at a healthier weight—and to take the next step forward by having a coordinator contact you. The coordinator can schedule a free, no-obligation consultation with a specialized, medical professional or reserve a spot for you at an upcoming educational seminar!

Discover The New You!

Personal Information

First Name*
Last Name*
Zip Code*
City
State
County
Phone*
Best Time To Call*
Email*
Date of Birth*
Gender*	FemaleMale
Height
Weight*	lbs.
BMI

Insurance Information

Health Insurance Company
Type of Health Insurance?
Group Number
Policy Number
Will you need financing for your procedure?	Yes No

Other Health-Related Information

Profession
State how this condition affects your life
Obesity-Related Conditions	High Blood Pressure Sleep apnea High Cholesterol Arthritis Venous stasis disease Soft Tissue Infections Type 2 Diabetes Obstructive Sleep Apnea Osteoarthritis/Joint Pain Prediabetes Other
Yes, I would like to receive news and updates about weight loss surgery

The information you provide on this form may be shared with a Third Party healthcare provider in your area. By completing this form you are authorizing us to disclose your individually identifiable health information to a Third Party healthcare provider.

Meet Our Doctors

		Dr. Russ Birdwell is board certified in general surgery by the American Board of Surgery and is a Fellow of the American College of Surgeons. He is also a member of the Texas Medical Association and the Alpha Omega Alpha Medical Honors Society. Last message received on 6/28 at 12:02 AM

		Dr. Michael Green developed an interest in surgical treatment for morbid obesity. He then went on to complete a fellowship in Advanced Laparoscopic and Bariatric Surgery at Providence Hospital and Howard University. He serves as Bariatric Medical Director at two Texas Hospitals and is currently based in Fort Worth.

Patient Testimonials
		"I love my new life! I cannot imagine what life would be like now if I had not gone through with the surgery." - Melissa

		“I had gastric bypass surgery and the weight truly just melted away along with all my health problems.” - Elisha

		“Gastric bypass surgery gave me a tool to change my life. I now have more energy to do the things I love most!” - Kacey