Patient Info

New Patients: Bariatric

Dear Patient,

Thank you for inquiring about our practice and surgical treatments for weight loss. Please read this information carefully and thoroughly. In order to enroll in our Bariatric Program and obtain a consultation, we require that all prospective patients complete the packet of forms below.
 
You will need the free Adobe Acrobat Reader to read/print them.
 
PLEASE NOTE *You will need to read either Gastric Bypass or LapBand options listed on the bottom of this page, in order to fill out some of these forms. The answers to some of the questions asked will be found in these topics.
Individual Forms - PDF Format:

 
Bariatric Enrollment Packet is found here.
 
 
Be Sure all forms are witnessed when required
 
Please mail these forms with your phone number to:
 
Shelby Baptist Medical Center
Bariatric Program
1000 1st North
Alabaster, AL 35007

 

ALL FORMS MUST BE COMPLETELY FILLED OUT
NOT COMPLETING THESE FORMS WILL DELAY SCHEDULING OF APPOINTMENT
 
After receiving all completed forms, we will then contact you by letter. Please be advised that in many circumstances, the initial bariatric consultation visit is not a covered expense. The cost will be between $175 and $250. We do accept Visa, MasterCard, American Express, and all Debit Cards. That amount is due and payable on your first visit.
 
 
Thank you for all your assistance. We look forward to meeting you in the near future.
 
Cahaba Valley Surgical Group, P.C. and Shelby Baptist Medical Center
 

Gastric Bypass :: LAP-BAND