I'VE MADE MY DECISION

Here is where You start to fulfill your dream!!

We, at Affordable Bariatrics, celebrate your decision. We will be very happy to strive as hard as we can to make of your surgery an uneventful and enjoyable experience.

The steps we will have to follow are:

Complete your basic information
We will send you a suggested date for surgery and financing information.
Coordinate clinic, hotel and airline reservations once you confirm us that your loan was approved or that you are planning to pay cash.
Coordinate payment procedures
Send you our "Next Steps" package
Receive you at the airport in Bogota (From that point on we will take care of you)

Fill this form completely and we will send back by mail the suggested scheduled date of surgery for your approval.

PLEASE READ VERY IMPORTANT NOTICE TO THE RIGHT

Please fill this form completely...
First Name:
Last Name:
City:
State:
Country:
eMail Address:
Confirm eMail Address:
Phone:
Age:
Height:	ft.
Weight:	lbs.
Maximum Weight ever Reached:	lbs.
Associated Pathologies: (If necessary, select more than one pathology by pressing the <Ctrl> key and clicking the left button of your mouse.)
If you suffer from other associated pathologies please fill the following field:	Other:
Previous Surgeries:
Do you drink alcohol ? :	Yes	No
	If you selected "yes", please state how often:
Do you smoke? :	Yes	No
	If you selected "yes", please state how many packs a day:
Current Medications:
When would you be planning to have your surgery? :
Which payment method are you planning to use ?	Cash
	Financing
Are you planning to bring a companion ?	Yes
	No
How did you came about Affordable Bariatrics ?:
	Other:
PLEASE REMEMBER to add asilva@affordablebariatrics.com to your safe emial addresses list, and to check your junk mail folder frequently.OTHERWISE YOU MAY MISS OUR RESPONSE. Thanks!

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Affordable Bariatrics:

TOLL FREE:

1-888-242-5702

Email:
Dr. Silva MD
asilva@affordablebariatrics.com

VERY IMPORTANT NOTICE!!

PLEASE BE AWARE

You may not get to see our response because of one of the following reasons:

1. Unfortunately Yahoo, Gmail, Hotmail and MSN have set some filters that will NOT let our emails go through, unless you have our email address in your safe list.

2. Microsoft Outlook may throw our email into your junk mail folder.

You may correct these problems by:

1. ADDING OUR EMAIL ADDRESS TO YOUR SAFE EMAIL ADDRESSES LIST: asilva@affordablebariatrics.com

2. CHECK YOUR JUNK MAIL FOLDER FREQUENTLY

PLEASE BE AWARE THAT YOU MAY MISS OUR RESPONSE IF YOU DO NOT HAVE THE UP MENTIONED PRECAUTIONS !!!!!!

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