Lap Band Patient Forms and Registration

Patient registration forms

We offer registration forms in preparation for your appointment.


You can download our forms and print them out to fax them or mail them to us. You will need to have Adobe Acrobat reader to open the files.




If you would prefer for us to contact you,
please fill out the following contact form





  • Maxcine has lost 89 pounds in a little over a year, and is still going strong! She used to take 15 medication pills per day, and is off of all of them. Way to go Maxcine!
  • We call Jeff "Mr Lap Band Oklahoma!" Jeff lost 130 pounds in the first year after Lap Band surgery. Here he is showing off with the belt he used to wear!
  • Kelli was just 19 years old when she had her Lap Band and lost over 170 pounds in the first year after surgery.
  • Amy has lost 78 pounds since surgery and has more energy and feels better than she did before!