If your goal is to lose weight, our experts can help. When combined with healthy lifestyle choices and a skilled, supportive care team, weight loss surgery, or bariatric surgery, can be an effective tool to help you lose weight — and keep it off.

Ready to take the next step in your weight loss journey? Start by finding out if you qualify for weight loss surgery by completing the form below.

• We will help verify your insurance benefits and see if you qualify for surgery.
• Complete the form below or call 832.667.5673.

 

*denotes required field

Patient Information Section

Patient First Name * Middle Name Patient Last Name * Address * Apartment/Unit City * State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Postal Code * Country of Residence * United States Date of Birth * Email Address * Phone * Patient's Gender Female Male Other

Do you currently have any of the following conditions?

Lipid abnormalities Gastrointestinal disorders Diabetes High blood pressure Heart disease Sleep apnea Non-alcoholic fatty liver Osteoarthritis

In order for us to assess your eligibility, please share your height and weight. *

Location Preferences Section

Preferred Location * Texas Medical Center (TMC) Baytown Clear Lake Cypress Katy/West Houston Sugar Land The Woodlands Willowbrook Preferred Doctor (if you have one)

Insurance Section

Are you insured? *

Yes No, I will self-pay for services

Health Insurance Plan Name * Policy, Subscriber or Member ID Number * Group Number/ ID# * Insurance Customer Service Number * Name as it appears on your insurance card *

Confirm you will self-pay by checking the box *

Yes, I will be self-paying for services

I would like to stay connected with Houston Methodist on upcoming events, health tips and newsletters.

Yes

Authentication *