The Mini-Gastric Bypass Surgery

Hints: Write it out on paper first, DO NOT Press the ENTER Key until you are done.
Patient #1	Patient #2	Patient #3	Patient #4	Patient #5
Patient #6	Patient #7	Patient #8	Patient #9	Patient #10

Your Identification Information:
Today's Date:

Your First Name
Your Last Name
Your Email Address
Patient Contact #1
First Name
Last Name
Method of Contact
Patient's email Address
Date of Mini-Gastric Bypass
PreOp Weight
Date of Contact
Weight Now
Patient Comments
Patient Contact #2
First Name
Last Name
Method of Contact
Patient's email Address
Date of Mini-Gastric Bypass
PreOp Weight
Date of Contact
Weight Now
Patient Comments
Patient Contact #3
First Name
Last Name
Method of Contact
Patient's email Address
Date of Mini-Gastric Bypass
PreOp Weight
Date of Contact
Weight Now
Patient Comments
Patient Contact #4
First Name
Last Name
Method of Contact
Patient's email Address
Date of Mini-Gastric Bypass
PreOp Weight
Date of Contact
Weight Now
Patient Comments
Patient Contact #5
First Name
Last Name
Method of Contact
Patient's email Address
Date of Mini-Gastric Bypass
PreOp Weight
Date of Contact
Weight Now
Patient Comments

This notice describes how information about you may be used and disclosed and how you can gain access to this information. Please review carefully

Contact Information: -Telephones: *** CLOS West: 702-714-0011, *** CLOS Florida: Flo Ballengee 863-899-3463, Dr. Peraglie 407-922-3424

Email Us Anytime for Help: Email: Everyone@clos.net or CLOSLasVegas@clos.net *** CLOS West DrR@clos.net, or CLOSLasVegas@clos.net *** CLOS Florida: Flo Ballengee Flo@clos.net, Dr. Peraglie DrP@clos.net

Addresses: Address: *** CLOS West: Dr. Rutledge / CELOS, 98 E Lake Mead Parkway, Suite 302, Henderson NV 89015, Telephone: 702-714-0011 Fax: 702-456-1173, Email: DrR@clos.net, Everyone@clos.net or CLOSLasVegas@clos.net *** CLOS Florida: 40124 Highway 27, Suite 203, Davenport, FL 33837, Flo Ballengee 863-899-3463, Flo@clos.net, Dr. Peraglie 407-922-3424 DrP@clos.net

Warning: Gastric Bypass Surgery is a MAJOR surgical procedure. It can be associated with significant risks and complications, up to and including death. Weight loss surgery is a rapidly developing area of medicine. Bariatric surgery is filled with controversy. It is very important to take a careful and deliberate approach to considering surgery for the treatment of obesity.

Disclaimer Notice:-Information on this web site is provided for informational purposes only.
-It is imperative that you consult your own physician regarding the applicability of any opinions or recommendations with respect to your symptoms or medical condition.
-Contact with this web site or Dr. Rutledge over the web site does not constitute a doctor patient relationship and for good quality medical care you must obtain advice and consultation form your own local physician.
-This site is intended as a resource for references on the treatment of obesity for health care professionals and educated consumers.
-The authors and editors have used sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication.
-Medical knowledge changes rapidly. In view of the possibility of human error or changes in medical science, neither the authors nor the editors nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they are not responsible for any errors or omissions or for the results obtained from the use of such information.
This information is not medical advice or diagnosis, nor is it to be construed as medical advice, medical information, medical diagnosis, or medical prescription for curing, removing, or preventing any disease, or related symptoms. You must seek the direct assistance, advice and evaluation of your own personal physician before acting on any information found herein. These statements have not been evaluated by the Food and Drug Administration.
-Readers are Strongly encouraged to discuss and confirm the information contained herein with your own physician.
Copyright � 1998 The Center for Laparoscopic Obesity Surgery