The first step to considering bariatric surgery at Grandview and Southview Hospitals is to learn about the surgery and our comprehensive program by attending one of our Informational Seminars. The seminars are designed for those interested in the surgery, as well as friends and family members -- all are welcome.

Seminar Registration
To register today for one of the free Informational Seminars please fill out the form below and submit your registration for a specific session date. Be sure to include your name, e-mail address and daytime telephone number. Seminar space is limited. We will contact you via e-mail or telephone to confirm your reservation.

Directions:
Southview Hospital
Grandview Hospital I-75 Construction Detour Directions
Cassano Health Center
Preble County Medical Center - Preble Location Instructions

Your 2008 Registration Information:
(All Fields Required)
You are interested in	Undecided Lap Band Roux-en-Y (Gastric Bypass)
Date, Location and   Time You're Attending	7/3_Southview_1:00pm 7/8_Grandview_5:30pm 7/15_Southview_5:30pm 7/22_Preble_5:30pm 8/7_Southview_1:00pm 8/12_Grandview_5:30pm 8/21_Southview_5:30pm 8/26_Cassano_5:30pm 9/4_Southview_1:00pm 9/9_Grandview_5:30pm 9/18_Southview_5:30pm 9/23_Cassano_5:30pm 10/2_Southview_1:00pm 10/14_Grandview_5:30pm 10/28_Cassano_5:30pm 11/6_Southview_1:00pm 11/18_Southview_5:30pm 11/25_Cassano_5:30pm 12/9_Grandview_5:30pm 12/16_Southview_5:30pm 12/23_Cassano_5:30pm
Name (First & Last)
Address
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Zip Code
Email
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Height	Feet Inches     Weight lbs.
Age
How Many Will   Attend This Seminar?	(counting you)
Insurer Name	Ex: Blue Cross
Have You Had Any   Previous Weight   Loss Surgery?   Which One?	Characters Left Below
How did you   hear about   our program?	TV    Radio   Newspaper Web  Mail     Phone Book Family / Friends Other
All information gathered from this form will only be used by Grandview Medical Center and not sold to or used by any third party.