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Lake Health Bariatric Surgery Center Health Questionnaire

Webinar Questionnaire

Congratulations, you're almost finished! Please complete the following questions and hit the submit button. All fields are required. Your information will be shared with our office for follow up within 2-3 weeks. We will contact your insurance company to determine your benefits or coverage for bariatric surgery before your consultation.

  • Contact Information

  • Medical Information

    This section asks information about you and your health:
  • MM slash DD slash YYYY
  • Include both feet and inches
  • In pounds

  • Insurance Information

    This section asks about health insurance. If you have health insurance, our team can help check to determine if your plan covers bariatric surgery and determine a range of what your cost may be based on your insurance plan’s deductible and out-of-pocket expenses.
  • Found on back of card.