How to Begin the Process of
Getting Approval for Your Surgery
Download several pages of information forms, which will enable us to begin the process of getting approval for Gastric Bypass, Roux en-Y. Print out these forms, and then fill in the information carefully and thoroughly – the more info we have about you, the better the case we can make for you, with your insurance carrier.
When the forms are completed, you may mail or fax them to us. We will also need a copy of your insurance card, both sides.
This information will be kept confidential, and will become an essential part of your medical record. We must have your approval, to communicate any information to anyone, even your own insurance carrier. We do not share your personal or medical information with anyone, for any other purpose.
Completed Registration Form
Completed Medical History
Copy of Insurance Card (Both
G. Wesley Clark, MD
6719 Road - Suite 205
San Diego CA 92120
FAX to: 619 265-1496
Phone: 619 265-1440
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