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1612-B Milstead Road NE
Conyers GA 30012
Phone: 770-602-1292
Fax: 770-602-1296/'
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General Surgery Forms
>>  Pre-Surgery Instructions
>>  Medical Release Form
>>  Processing & Completion of All Forms
>>  Patient Medical History
>>  Patient Acknowledgement
>>  Registration Form

Duodenal Switch (DS) Forms
>>  20 Year Diet Weight Loss Program History Worksheet
>>  20 Year Exercise Program History
>>  Bariatric Medical & Professional Providers of Service
>>  Important Information To Know
>>  Processing & Completion of All Forms
>>  Patient Medical History
>>  Patient Acknowledgement
>>  Registration Form
>>  Weight Loss Surgery Personal Decision

Lap Band Forms
>>  20 Year Diet Weight Loss Program History Worksheet
>>  20 Year Exercise Program History
>>  Important Information To Know
>>  Processing & Completion of All Forms
>>  Patient Medical History
>>  Patient Acknowledgement
>>  Registration Form
>>  Weight Loss Surgery Personal Decision

Bariatric Program Requirement Forms
>>  Nutrition Log
>>  Exercise Log

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Disclaimer: This information is not a substitute for a consultation with your own physician. You should make your own decision on whether
to pursue obesity surgery, and which procedure is right for you, based on a consultation with the doctor of your choice.
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