Skip to content
Baritrax Portal
Bill Pay
Careers
Find a Doctor
English
Español
Search
941-254-4957
Search for:
Weight-Loss Options
Laparoscopic Gastric Bypass
Robotic Sleeve Gastrectomy
Lap-Band® System
Patient Information
Understanding Obesity
Frequently Asked Questions
Weight-Loss Surgery Process
Postoperative Diet Guide
Postoperative Nutrition Guide
Patient Paperwork
Patient Portal
Weight-Loss Blog
No Surprises Act
Seminars & Support
Weight-Loss Seminars
Weight-Loss Support Group
Success Stories
Ciera’s Story
Gianna’s Story
Jenny’s Story
Jill’s and Paul’s Story
Jonathan’s Story
Katrina’s Story
Kristina’s Story
Pedro’s Story
Sarah’s Story
Contact Us
Weight-Loss Options
Laparoscopic Gastric Bypass
Robotic Sleeve Gastrectomy
Lap-Band® System
Patient Information
Understanding Obesity
Frequently Asked Questions
Weight-Loss Surgery Process
Postoperative Diet Guide
Postoperative Nutrition Guide
Patient Paperwork
Patient Portal
Weight-Loss Blog
No Surprises Act
Seminars & Support
Weight-Loss Seminars
Weight-Loss Support Group
Patient Testimonials
Ciera Lemoniades
Gianna Soussan
Jenny Rodriguez
Jill and Paul Grivas
Jonathan Bahm
Katrina Labadie
Kristina Babcock
Pedro Alfaya
Sarah Blinkhorn
Contact Us
Baritrax Portal
Bill Pay
Careers
Find a Doctor
English
Español
Register for Seminar
Search for:
Lose Weight Now
UHS Digital
2023-09-18T13:23:40-04:00
Lose Weight Now
For more information, fill out the form below or call
941-254-4957
Name
First
Last
Phone
Email
DOB
Height
Weight
Health Information
Chronic Health Conditions (e.g., diabetes, sleep apnea, hypertension, etc.)
Add
Remove
use the plus + to add additional conditions
Prior History of Bariatric Surgery?
Yes
No
Surgery Type
Date of surgery
Insurance Information
Do you have insurance?
Yes
No
Primary Insurance Plan Name
Primary Insurance Member Number/ID
Primary Insurance Provider Phone Number (on the back of card)
Page load link
Go to Top