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* 1. Please provide your information so you can be contacted regarding your interest in weight loss surgery.

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* 2. How did you hear about the weight loss surgery program at St. Mark's Hospital? (Select all that apply)

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* 3. Which medical conditions are related to obesity?

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* 4. Which of the following contributes to the disease of obesity?

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* 5. Our weight loss surgery program offers which of the following weight loss surgeries? (Check all that apply.)

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* 6. True or False: Studies have shown that bariatric or weight loss surgery is an effective treatment for metabolic diseases such as diabetes.

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* 7. Which of the following statements are true regarding weight loss surgery? (Check all that apply.)

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* 8. What changes must a weight loss surgery patient make for long term weight loss success? (Check all that apply.)

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* 9. True or False: A lap band is a restrictive procedure that can help an individual lose 40-50% of their excess weight at 5 years. It is adjustable and requires frequent follow up with the surgeon to achieve optimal weight loss.

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* 10. Which of the following is true regarding a lap band? (Select all that apply.)

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* 11. True or False: A sleeve gastrectomy helps you to feel full on less food. Food enters the digestive tract normally.

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* 12. Which of the following is true of the sleeve gastrectomy? (Select all that apply.)

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* 13. True or False: The Roux-en-Y gastric bypass is considered the gold standard weight loss surgical procedure because it has been around the longest and is the most studied.

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* 14. Which of the following is true of the gastric bypass? (Select all that apply.)

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* 15. True or False: The duodenal switch is the most powerful of the weight loss surgeries offered but also has higher risks.

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* 16. Which of the following is true of the duodenal switch? (Select all that apply.)

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* 17. I have watched all of the weight loss surgery videos and understand that weight loss surgery has risks. I have researched this decision and believe that this is the right direction for me and my health.

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* 18. Please let us know if you have any other questions by emailing Alicia Allen, Director of St. Mark's Weight Treatment Center directly.


Alicia.Allen@Mountainstarhealth.com

Thank you for completing our online weight loss surgery seminar. If you have decided that surgery is right for you, please follow the link below to download the patient forms and take the next step to surgery and can be found in our Pathway to Surgery. 

The next step is to fill out the patient information form completely and send it into the surgeon office {FAX 801-268-3997}. Please include a copy of your health insurance card if you will be using your health insurance to help pay for surgery. The contact information for the surgeon's office is 801-268-3800 or forms@rmapinc.com.

Once your paperwork is turned in, the surgeon’s office will contact your insurance company to verify your benefits and let you know what criteria has to be met to get a pre-approval for surgery. If you are needing a nutrition evaluation or a psychological evaluation, the St. Mark’s dietitians and social worker can help you complete those requirements. To schedule an appointment with them call 801-268-7479.

Please let me know if you have any other questions about weight loss surgery. We look forward to working with you!

Alicia Allen, MBA, RD
St. Mark's Weight Treatment Center
Alicia.Allen@Mountainstarhealth.com
Office: 801-268-7479
Direct: 801-268-7459


 

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