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FIRST NAME
LAST NAME
I allow Lonestar Bariatrics to use the information below on the website and other social media platforms
PRE-SURGERY WEIGHT
POST-SURGERY WEIGHT
SURGERY
1. HOW DID YOU HEAR ABOUT LONESTAR BARIATRICS?
2. TELL US ABOUT HOW YOUR PHYSICAL HEALTH AND / OR MENTAL HEALTH HAS IMPROVED.
3. WHAT ARE YOU ABLE TO DO SINCE YOU’VE LOST WEIGHT THAT YOU COULDN’T DO BEFORE SURGERY?
4. TOTAL WEIGHT LOST – HOW MUCH WEIGHT DID YOU LOSE IN THE FIRST 3 MONTHS POST-SURGERY? 6 MONTHS? A YEAR?
5. WHAT WAS YOUR OVERALL IMPRESSION OF DR. CARLTON AND HIS STAFF?
6. ADDITIONAL COMMENTS YOU WOULD LIKE TO SHARE.
7. BEFORE AND AFTER PHOTOS Before/After Photos you would like to share – please send in original format no pic collage or cut pics: Max. file size: 5 MB.
8. VIDEOS Videos you would like to share – if you want to video yourself answering the questions above – our marketing team will work their magic and compile (optional): Max. file size: 5 MB.
By completing this form, you are giving us permission to follow-up by phone, email or text.
*Actual Successful & Satisfied LoneStar Patient