 469-620-0222  469-620-0223 Patient Portal Login DFW Bariatrics Vitamin and Supplement Store Pay your Bill

Follow us on:     

Open/Close Menu

Skip to content

Home
General Surgery
Weight Loss Surgery
Non-Surgical / Medical Weight Loss
Appointment
Vitamin Store
Blog
About Us

Weight Loss Candidate Form

Home » Weight Loss Candidate Form

Are You a Candidate for Our Program?

Take our 60 Second Assessment to Find Out.

Step 1 of 9

0%

I am...*
- Male
- Female

Have you tried diet and exercise programs without durable success?
- Yes
- No

Do you suffer from any of these health issues?*
- Heartburn / Acid Reflux
- Sleep Apnea
- Joint Issues
- High Blood Pressure
- Diabetes
- Heart Disease
- None

What is your height and weight?
Height (ft)
Height (in)
Weight (lbs)?

What Major Concerns Do you have*
- Can I afford it?
- Is Surgery right for me?
- Safety of Surgery?
- Will I keep the weight off in the long-term?
- Other concern?
- No concerns

Which treatment is right for you?*
- Medically Supervised Weight Loss
- Endoscopic Sleeve Gastroplasty or Gastric Balloon
- Gastric Sleeve
- Gastric Bypass
- Duodenal Switch
- Bariatric Surgery Revision
- Not Sure at this time

Enter your information below to receive your Personalized Results
Name*
First Name Last Name
Email*
Phone*

What is your BMI?*
- Over 30 (kg/m2)
- Under 30 (kg/m2)
Based on the provided information, you likely do qualify for our program, would you like to send your information to our office?*
- Yes
- No
Your BMI (ratio of weight and height) are currently too low for our Weight Loss program. Would you like someone from the office to call you?*
- Yes
- No

Thank you, your information has been sent to the office
Thank you, someone will be reaching out to you.
Thank you for taking our 60 second assessment
Would you like a FREE insurance verification for weight loss services?*
- Yes
- No
CAPTCHA

Quick Links

About Us
Minimally Invasive General Surgery Dallas, Fort Worth
Weight Loss Surgery Dallas, Fort Worth
Non-Surgical Weight Loss Treatment Dallas, Fort Worth
Anti-Reflux Surgery Dallas, Fort Worth

Click here for driving directions and location map.

Contact Us

Sachin S. Kukreja, MD FACS FASMBS
Elizabeth A. Hooper, MD FACS FASMBS
DFW Bariatrics and General Surgery

1411 N. Beckley Avenue
Pavilion 3, Suite 454
Dallas, TX 75203

Tel : 469-620-0222
Fax : 469-620-0223
E-mail : [email protected]

Sachin Kukreja, MD

Sachin Kukreja, MD

4.9

Elizabeth Hooper, MD

4.9

Stay Connected

Facebook
Twitter
Linkedin
Instagram
Youtube
TikTok

Facebook Feeds

Facebook Posts

View on Facebook

Unable to display Facebook posts.
Show error

Error: (#12) deprecate_post_aggregated_fields_for_attachement is deprecated for versions v3.3 and higher
Type: OAuthException
Code: 12
Please refer to our Error Message Reference.

Now DFW Bariatrics and General Surgery, formerly known as Sachin Kukreja, MD.

© DFW Bariatrics and General Surgery, Dallas, TX 2023

↑

Search for: