Matthew St. Laurent MD - Advanced Laparoscopic Bariatric SurgeryAmerican Society for Metabolic and Bariatric Surgery Your Practice Online
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Matthew St. Laurent MD - Advanced Laparoscopic Bariatric Surgery
Matthew St. Laurent MD - Advanced Laparoscopic Bariatric Surgery
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   Seminar Place North Cypress Cy-Fair Methodist Office
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Documented Medical Conditions Hypertension Type II Diabetes Sleep Apnea
Coronary Artery Disease Osteoarthritis
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What Surgical Weight Loss Procedure are you interested in? (please check one)
Roux-en-y Gastric Bypass Gastric Sleeve/ Vertical Gastrectomy Adjustable Gastric Banding
Roux-en-y Gastric Bypass Gastric Sleeve/ Vertical Gastrectomy Adjustable Gastric Banding
Insurance
I,      Yes; I do No; I don't hereby authorize Matthew St Laurent MD to verify insurance benefits. I authorize the release of Insurance Payments directly Mattbew St. Laurent MD and to release any information obtained in the course of my evaluation and treatment to permit processing of claims for insurance reimbursement. A photocopy of my signature is valid.
 

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