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Consultation Request



First Name (*)
Last Name (*)
Email Address (*)
Enter your phone number (*)
Which date would you prefer? (*)
Which time would you prefer? (*)





Why add insurance information?

Optionally adding your insurance information will help expedite your check in process when you arrive for your scheduled consultation.


Insurance Information

Your insurance provider requires the following information for verification purposes. Please fill out the following form with the Primary Insurance Card Holder Information:

What is your relationship to the Primary Insurance Card Holder?
Primary Card Holder's First Name
Primary Card Holder's Last Name
Date of Birth

NOTE: Bariatric Solutions cannot accept coverage under Medicaid.
Insurance Provider
Primary Card Holder's Employer
Insurance Subscriber/Member ID

Invalid Input
Insurance Group/Account Number

Insurance Provider Phone Number

YOUR HEALTH INFORMATION:

Please answer the following questions about YOU and your HEALTH
Height (ft. in.)
Weight (lbs.)
Do you have any of the following health issues?












Our insurance specialists will review your insurance information and attempt to verify your bariatric weight-loss surgery coverage. This process may take several days and require additional information from you. Our goal is to get your insurance information answered within 7 working days.




Weight Loss Surgery Clinics


Dallas Bariatric Clinic
(NEW LOCATION)
8100 Lomo Alto, Suite 100, Dallas, TX 75225

New Extended Hours: 7 am to 5 pm
Toll Free: 888-576-9892
Local: 940-249-9009

Decatur Bariatric Clinic
2010 S Ben Merritt Drive Ste B, Decatur, TX 76234

 New Extended Hours: 7 am to 5 pm
Toll Free: 888-576-9892
Local: 940-249-9009

Fort Worth Weight Loss Surgery Clinic OPEN NOW 4312 Heritage Trace Parkway, Ste. 704 in Keller, TX 76248