Online Seminar Registration

Welcome!

Watching this free informational 10 minute video is required for anyone considering weight loss surgery within our program. It is the first step towards a healthier you, and gives you a quick overview of your weight loss options!

We highly recommend taking notes! You must complete the entire video and download the forms to be eligible to make an appointment. Once you complete the video please call the office of Dr. Aaron Siegel or Dr. Amit Parikh to schedule. Bring your filled out forms to your first doctor’s appointment or write the answers on a separate sheet of paper.

To request a paper copy or for questions about the program, please feel free to contact us at VistaWMO@quorumhealth.com.

First Name Last Name * Birth Date Phone Number (xxx-xxx-xxxx) Email Address Height (Feet and Inches, x' xx") Weight (Pounds) Which physician would you like to see? Please Select... No Preference Amit Parikh, DO Aaron Siegel, MD How did you hear about us? Please Select... Social Media Website Referral Friend