Bariatric Registration Form

Register for an upcoming Bariatric Seminar or Support Group Session.

Form completion below for the Bariatric Program at MacNeal Hospital. Outbound attempts will need to be made to register the consumer for either an upcoming seminar OR to inform them that they will be put on a coordinator callback report, for further follow up to their questions. Go to SERVICES: SURGICAL WEIGHT LOSS – MNH. Go to CLASS: Wellness & Weight Management Information Sessions OR Bariatric Coordinator. 

000-000-0000

Bariatric Informational Seminars

I would like to register for:
Which informational seminar date would you like to attend?










Bariatric Support Group

I would like to register for:
Which support group date(s) would you like to attend?










Select the statement below to submit form.