Bariatric Appointment Call

Bariatric Seminar Registration

 Bariatric Surgery Accredited Center of Excellence 

Registration Form

Weight Loss Surgery Seminar Registration

* Denotes a required field
 Registrant Information
*First Name *Last Name
*Date of Birth
   mm/dd/yyyy
 Age:  Gender Female Male
*Phone # *Email
Address City
State ZIP
 Insurance Information
Name Other
Policy # Group ID
 Additional Information
Referred By Other
Other Comments
 Class Schedule for 2014
Select a class by clicking on a date below: 
South Nassau Communities Hospital
Thu, Dec 11, 14 6:00 PM Conference Rooms A and B
Thu, Jan 15, 15 6:00 PM Conference Rooms B and C
Thu, Feb 19, 15 6:00 PM Albert Conference Room
Thu, Mar 19, 15 6:00 PM Conference Rooms B and C
Thu, Apr 16, 15 6:00 PM Conference Rooms A and B
Thu, May 21, 15 6:00 PM Albert Conference Room
Thu, Jun 18, 15 6:00 PM Conference Rooms B and C
Thu, Jul 16, 15 6:00 PM Albert Conference Room
Thu, Aug 20, 15 6:00 PM Conference Rooms B and C
Thu, Sep 17, 15 6:00 PM Albert Conference Room
Thu, Oct 15, 15 6:00 PM Conference Rooms B and C
Thu, Nov 19, 15 6:00 PM Albert Conference Room
Thu, Dec 10, 15 6:00 PM Conference Rooms B and C

 
 If you have any questions or need help completing this form, please call the Center for Weight and Life Management at 516-374-8631.

Compliance and Privacy Policies for Vendors and Patients
• © 2013 South Nassau Communities Hospital • One Healthy Way • Oceanside, NY 11572
• 1-877-SouthNassau (877-768-8462)

Like us on Facebook Follow us on Twitter Watch us on Youtube Donate a Gift to South Nassau Send secure emails to physician

Web Analytics