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Disclosure Form (PDF)
Patient Information Form (PDF)
Financial Agreement Release (PDF)
Past Medical History (PDF)
Laparoscopic Adjustable Gastric Banding Consent Form (PDF)
Laparoscopic Roux-en-y Gastric Bypass Consent Form (PDF)

Access the Personal Electronic Medical Record of a Spouse or Parent
(Please note: You are required to complete and sign this form and give it to your physician practice.)

MyChart Proxy Request Form (PDF)





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