Bariatric Support Group Registration *STOP* If you haven't yet completed your informational session please visit https://www.inspirahealthnetwork.org/form/bariatric-virtual-session to complete that prior to registering for a support group in the following month AFTER your online information session This Registration is for our New Beginnings Support group meant for patients prior to Surgery. If you have already had surgery, please contact BariatricsVoicemails@ihn.org to register for our Graduate Support group. Name First Last Date of Birth Date of Birth Email Address Phone Number Do you have Aetna insurance? Yes No May we send you health information by email? Yes No Surgeon Dr. Ahmed Attia DO Elmer or Vineland Dr. Derek Stephenson, MD Elmer or Vineland Dr. Christopher Bashian DO Mullica Hill Dr. Charles McCann MD Mullica Hill Do You Require Translations Services? - Select -- Select -YesNo- Select -YesNo What is your Primary Language? - Select -- Select -AfrikaansAmharicArabicAsturianAzerbaijaniBelarusianBulgarianBengaliTibetanBretonBosnianCatalanCzechWelshDanishGermanDzongkhaGreekEnglishEnglish, BritishEsperantoSpanishEstonianBasquePersian, FarsiFinnishFilipinoFaeroeseFrenchFrisian, WesternIrishScots GaelicGalicianSwiss GermanGujaratiHawaiianHebrewHindiCroatianHaitian CreoleHungarianArmenianIndonesianIcelandicItalianJapaneseJavaneseGeorgianKazakhKhmerKannadaKoreanKurdishKyrgyzLaoLithuanianLatvianMalagasyMacedonianMalayalamMongolianMarathiBahasa MalaysiaMalteseBurmeseNepaliDutchNorwegian BokmålNorwegian NynorskOccitanOdiaOssetianPunjabiPolishPersian, AfghanistanPashtoPortuguese, InternationalPortuguese, PortugalPortuguese, BrazilRohingyaRumantsch GrischunRomanianRussianKinyarwandaScotsNorthern SamiSinhalaSlovakSlovenianAlbanianSerbianSwedishSwahiliTamilTamil, Sri LankaTeluguThaiTurkishTuvanUyghurUkrainianUrduVietnameseLolspeakChinese, SimplifiedChinese, Traditional- Select -AfrikaansAmharicArabicAsturianAzerbaijaniBelarusianBulgarianBengaliTibetanBretonBosnianCatalanCzechWelshDanishGermanDzongkhaGreekEnglishEnglish, BritishEsperantoSpanishEstonianBasquePersian, FarsiFinnishFilipinoFaeroeseFrenchFrisian, WesternIrishScots GaelicGalicianSwiss GermanGujaratiHawaiianHebrewHindiCroatianHaitian CreoleHungarianArmenianIndonesianIcelandicItalianJapaneseJavaneseGeorgianKazakhKhmerKannadaKoreanKurdishKyrgyzLaoLithuanianLatvianMalagasyMacedonianMalayalamMongolianMarathiBahasa MalaysiaMalteseBurmeseNepaliDutchNorwegian BokmålNorwegian NynorskOccitanOdiaOssetianPunjabiPolishPersian, AfghanistanPashtoPortuguese, InternationalPortuguese, PortugalPortuguese, BrazilRohingyaRumantsch GrischunRomanianRussianKinyarwandaScotsNorthern SamiSinhalaSlovakSlovenianAlbanianSerbianSwedishSwahiliTamilTamil, Sri LankaTeluguThaiTurkishTuvanUyghurUkrainianUrduVietnameseLolspeakChinese, SimplifiedChinese, Traditional NOTE: Your Bariatric Support group should NOT be scheduled in the same month you completed your information session. If you completed your information session in the current month please register for the next months support group. We Reserve the right to cap capacity of classes and or change scheduled speakers. Please do not register for any class marked filled. Please Register Me for Virtual Bariatric Support Group scheduled on: **CLOSED DO NOT REGISTER**Monday, July 21, 20257pm Online on Microsoft Teams with Bariatric Coordinator Bradee Rojas Wednesday, August 6, 20257pm Online on Microsoft Teams with Bariatric Coordinator Tiffany Lilly Monday, August 18, 20257pm Online on Microsoft Teams with Bariatric Coordinator Bradee Rojas Wednesday, September 3, 20257pm Online on Microsoft Teams with Bariatric Coordinator Tiffany Lilly Monday, September 15, 20257pm Online on Microsoft Teams with Bariatric Coordinator Bradee Rojas Wednesday, October 1, 20257pm Online on Microsoft Teams with Bariatric Coordinator Tiffany Lilly Monday, October 20, 20257pm Online on Microsoft Teams with Bariatric Coordinator Bradee Rojas Wednesday, November 5, 20257pm Online on Microsoft Teams with Bariatric Coordinator Tiffany Lilly Monday, November 17, 20257pm Online on Microsoft Teams with Bariatric Coordinator Bradee Rojas Wednesday, December 3, 20257pm Online on Microsoft Teams with Bariatric Coordinator Tiffany Lilly Monday, December 15, 20257pm Online on Microsoft Teams with Bariatric Coordinator Bradee Rojas CAPTCHA Math question 4 + 6 = Solve this simple math problem and enter the result. E.g. for 1+3, enter 4. ***If this is an emergency or you are experiencing chest pain, shortness of breath, or an allergic reaction, please call 911 or report to your closest Emergency Room immediately. Do not use this form for urgent medical needs. Upon Completion of your selected group a Microsoft Teams Invite will be emailed to you within 7 business days. If you have any issues or concerns contact Bariatricsvoicemails@ihn.org and your Bariatric Coordinator will respond OUR GROUPS ARE SCHEDULED FOR 7:00PM WEDNESDAYS AND MONDAYS. PLEASE BE MINDFUL OF THE DATE AND DAY YOU ARE REGISTERING FOR. Leave this field blank
