thank you

PLEASE TELL THE PATIENT: "You should have just received a text message letting you know that it takes us 1 to 2 business days to check your insurance. We'll text you as soon as we hear back from your insurance company." STAFF REMINDER: Before submitting a new form, please refresh this page.

Take the First Step: Schedule Your Free Live Webinar

What type of patient is this?

   
Your body mass index (BMI) only qualifies you for the Gastric Balloon procedure. Please change your procedure selection to “Gastric Balloon” if you would like to proceed. Change to Gastric Balloon to proceed