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Weight Loss Surgery > The Process > Registration Form

Registration Form

For questions about the weight loss surgery program, call 410-601-4486, or complete the form below and someone will contact you.

Please fill out the following fields and then click Submit.

*Indicates required information

* First Name:


* Last Name:


* Email:


* Phone Number:



  Do you have a BMI of > 40 (Check your BMI):

  Do you have a BMI of 35 – 39.9 with High blood pressure, Diabetes, Coronary artery disease, Obstructive Sleep apnea, Pseudotumor cerebrii:

  Do you use a wheelchair within your home?:

  Have you had previous surgery for reflux?:

  Have you had previous sleeve, gastric bypass, or lap band surgery outside of LBH?:

  If yes, are you experiencing any problems with that surgery (not including weight gain?):