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    FIRST NAME

    LAST NAME

    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.

    Contact LoneStar
    Bariatrics Today

    CONTACT US(972) 232-7171

    *Actual Successful & Satisfied LoneStar Patient

    Contact Us (972) 232-7171