Obesity Medicine Seminar form - Gundersen Health System

Weight Management: Obesity Medicine Seminar Request

Request additional information after watching the Obesity Medicine Seminar.

Request additional information

Please fill out the form below. We will contact you within 1-2 business days.

IMPORTANT: Please only select interest in Weight Loss Medications or OPTIFAST Meal Replacement Program if you believe you are eligible based on the information in the seminar.

Eligibility for medications or OPTIFAST:

You must have a body mass index (BMI) of 30 or greater, or BMI of 27 or greater with at least one weight-related medical condition.
You must be at least 16 years of age.

Calculate your BMI

By checking the box below, I verify that I watched the Obesity Medicine Seminar from start to finish.

Your name

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I want visits with a dietitian (without weight loss medication and without OPTIFAST)

I want a medical assessment with a doctor to determine if Weight Loss Medications or the OPTIFAST Meal Replacement Program is right for me.

I have more questions before I can decide. Please contact me to arrange a time for a registered dietitian to answer my questions.

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