Weight Loss Surgery - Bariatric Surgery - Free Consultation

Are you tired of making excuses for how you feel about yourself?  If you are stuck in a body that is not responding to temporary diets and are ready to commit to your health permanently then it’s time to act NOW!.  There are many reasons for obesity.  The heavier you are, the more you are at the risk of developing serious debilitating medical issues that will have significant impact on your quality of life.

If you are overweight and it prevents you from leading a normal lifestyle and feeling good about yourself, we can help you determine which weight loss surgical procedure is the right option for you.
Weight loss surgery will reduce the adverse effects of excessive weight and alleviate the serious physical, emotional, social and even economic consequences of the disease.

Contact Information:
First Name  *
Last Name  *
Occupation  *
Address 1  *
Address 2
City  *
State  *	? Alabama Alaska Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific Alberta, Canada British Columbia, Canada Labrador, Canada Manitoba, Canada New Brunswick, Canada Newfoundland, Canada Northwest Territories, Canada Nova Scotia, Canada Nunavut, Canada Ontario, Canada Prince Edward Island, Canada Quebec, Canada Saskatchewan, Canada Yukon, Canada
Postal Code  *
Phone  *
Email  *
Clinical Information:
Date of Birth  *	? January February March April May June July August September October November December ? 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 ? 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Age
Gender  *	? Female Male
Height  *	? 4 5 6 feet 0 1 2 3 4 5 6 7 8 9 10 11 inches
Weight  *	pounds
BMI
Previous Weight Loss Surgeries:
Surgery  *	? Lap Band Gastric Sleeve Gastric Bypass Sleeve Plication Mini Gastric Bypass Duodenal Switch Revision Undecided --- Other --- Cancer Dental Dermatology Heart Disease Plastic Surgery Stem Cell
Location  *	? Tijuana Monterrey Cancun Puerto Vallarta
Medical Conditions:
Additional Information:
How were you referred to us?  *	? Google Yahoo MSN Friend Other
Are you interested in financing?  *	? Yes No
Time frame for surgery?  *	? Immediately 3-6 months 6-9 months
Comments:
Captcha  *

Due to the nature of Internet communications, no privacy statement - including this one - can address all the factors on the visitor's system or the systems involved in connecting visitors to our site. We will do our best to uphold privacy on our end of the communications.

This website was created for Ready 4A Change, LLC. Your identity, contact and medical information will be treated absolute confidentially and will not be shared with any organizations or individuals outside Ready 4A Change and will be used for the sole purpose of determining your eligibility for the medical procedures you have expressed interest in.

• Ready 4A Change will make the information provided on your e-letter and application available only to the medical and office staff of the doctors we represent.
• The email addresses of those who fill out an e-letter are stored in a database. This database will be used for client contact information for our doctors and staff.
• Ready 4A Change will not sell any personal or medical information you provide (such as your name or contact information), nor will it make available your information to any organization or individual without your express consent.

Outside Links:
This site contains links to other sites. www.ready4achange.info is not responsible for the privacy practices or the content of such Web sites.

Web Site Statistics:
Statistics kept on this site aggregate usage information for campaign evaluation purposes. These statistics do not reveal personal information.

If you have any questions about this privacy statement, the practices of this site, or your dealings with this Web site, you can contact: info@ready4achange.com