Confidential Inquiry

*First Name:

*Last Name:

*Age:

*Phone Number:
() -
*Street Address:

*City

*State        *Zip Code:
       
*email:

Gender:

Height:
FeetInches
Weight:
lbs
BMI:

Message:



  • Are you 30 pounds or more overweight?
  • Are you unable to lose weight or keep weight off by dieting?
  • Do you have Diabetes? High blood pressure?
  • Do you feel obesity diminishes your quality of life or self esteem?

You may be able to participate in a study conducted by the surgeons of:

Southern California Advanced Laparo-Endoscopic Surgery
&
Sacramento Advanced Laparoscopic Surgery Associates

EFFECTS OF
LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING
WEIGHT LOSS SURGERY
ON PATIENTS WITH
BODY MASS INDEX (BMI) OF 30 TO 35 KG/M²

(* FDA IDE Number: G***08* / * WIRB Study Number: 1***87*)

FOR MORE INFORMATION CALL TOLL FREE
1 - 877 - 3035 - BMI
1 - 877 - 303 - 5264

- All information collected will become part of the study and will not be shared in any way with clinicians or agencies not associated with this investigation -