For your convenience please print out documents and complete. Bring this info packet along with copies of the front and back of your insurance card and a photo ID to the seminar.
Do not send this form in before you have attended a seminar as it will not be processed until you have signed in and completed the seminar.
Please contact our Bariatric Initial Care Specialist at (913) 948-5370 if you have any questions. Email the completed form to email@example.com with a copy of your insurance card.