Congratulations on your decision to take that important first step to permanent weight loss. Just fill out the form below and tell us about your current medical condition. After surgeon review and approval our Patient Coordinator will contact you with a booking proposal and important pre-op information.

Name

Surname

Email

Age

Gender

Height (cm)

Weight (kg)

BMI

Pre-Existing Medical Conditions:
DiabetesArterial Hypertension
ArthritisAcid Reflux
Chronic GastritisVenous Insufficiency
HypercholesterolemiaGastric Ulcer
Cancer RelatedPsychiatric Related

Previous surgical procedures, if any?

Known allergies to medications?

Currently taking any medications?

Ever had a blood transfusion?

Please describe your dieting history, types, duration, drugs or medications used.

Please enter your referral code.

19/21 Vienības prospekts,
Jurmala, LV-2010 Latvia
+371 2837 2898

Feel the Difference

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Need Financing Help?

If you’re having problems finding the cash for surgery, please contact us. We have many sources of short term financing.
Email us with financing request