The First Step
History Form
The first step of the process is to download and print the form listed below, fill it out and mail or fax it in to the clinic. The mailing address and fax number are at the bottom of this page. Providing us with this information will allow us to do the following:
- Evaluate your specific health situation to determine if you qualify for surgery
- Let you know what vitamins, protein supplements, etc you will need to obtain before surgery
- Determine if your insurance offers benefits
- Write a letter of medical necessity to your insurer
When the form is received in the office, you will be contacted and scheduled for an endoscopy to evaluate your pouch and stoma, to determine if you are a candidate for the ROSE or StomaphyX procedures.
Fax or deliver the completed forms to the following location:
Fax (619) 286-7867
Address:
Ellner Bariatric
5555 Reservoir Drive Ste 203
San Diego, CA 92120
