Bariatric Support Group Registration

*STOP* If you haven't yet completed your informational session please visit https://www.inspirahealthnetwork.org/form/bariatric-virtual-session to complete that prior to registering for a support group in the following month AFTER your online information session

This Registration is for our New Beginnings Support group meant for patients prior to Surgery. If you have already had surgery, please contact BariatricsVoicemails@ihn.org to register for our Graduate Support group.

First

Last

Date of Birth

Email Address

Phone Number

Do you have Aetna insurance?

Yes

May we send you health information by email?

Yes

Surgeon

Dr. Ahmed Attia DO

Elmer or Vineland

Dr. Nauveed Iqbal MD

Elmer or Vineland

Dr. Derek Stephenson, MD

Elmer or Vineland

Dr. Christopher Bashian DO

Mullica Hill

Dr. Charles McCann MD

Mullica Hill

Do You Require Translations Services?

What is your Primary Language?

NOTE: Your Bariatric Support group should NOT be scheduled in the same month you completed your information session. If you completed your information session in the current month please register for the next months support group.

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Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.

***If this is an emergency or you are experiencing chest pain, shortness of breath, or an allergic reaction, please call 911 or report to your closest Emergency Room immediately. Do not use this form for urgent medical needs.

Upon Completion of your selected group a Microsoft Teams Invite will be emailed to you within 7 business days. If you have any issues or concerns contact Bariatricsvoicemails@ihn.org and your Bariatric Coordinator will respond

OUR GROUPS ARE SCHEDULED FOR 7:00PM WEDNESDAYS AND MONDAYS. PLEASE BE MINDFUL OF THE DATE AND DAY YOU ARE REGISTERING FOR.

The material set forth in this site in no way seeks to diagnose or treat illness or to serve as a substitute for professional medical care. Please speak with your health care provider if you have a health concern or if you are considering adopting any exercise program or dietary guidelines. For permission to reprint any portion of this website or to be removed from a notification list, please contact us at (856) 537-6772