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Register Now 2017-03-30T14:36:35+00:00

Patient Registration

Thank you for beginning the initial registration process, we are excited to have you as a patient! You have taken the first step in your weight loss surgery journey, and remember, we will be by your side to help you through the entire process.

The reason for the extensive registration process is to collect health and diet information for your medical record. This information will be used to determine eligibility for surgery and any important health information regarding obesity related medical conditions.

You now have two options in this initial registration process:

Download Complete Registration Form

If you are ready today, you can proceed to “Complete Registration” and finish the entire registration process. After downloading and completing the registration form, email the completed form to tracy [@] weightloss-la.com. Someone from our office will then contact you to schedule an initial consultation with Dr. Bellanger.

Download Registration Form

Online Pre-Registration Form

If you simply desire to know if you are a candidate for weight loss surgery or if your insurance company will pay for such a procedure, you can complete the initial “Pre-Registration Form” and our office will be in contact with you. Upon completion you may return to the web site homepage to continue browsing and gathering information.

Online Pre-Registration