If you are would like to register for the message board on our site or would like to know more about our program, please fill out the form below. The more information you supply, the better we will be able to assist you. You may phone us at 570-969-2527. *Please note, this will sign you up for the message board only, it will not get you a profile. If you wish to have a profile in addition to access to the message board, sign up here instead. You are Learning about surgery Hoping to have surgery Post Op - Planning a revision TitleMrs.Ms.Mr. First Name Last Name Email Height Feet: Inches: Weight: pounds Age Phone Best time to call City State Zip Insurer Name Ex: Blue Cross Policy Name Ex: HealthShield POS Questions? If we are unable to help you, do we have your permission to forward your information to another qualified bariatric surgeon near you? YesNo
