Instructions for Submission of Patient Testimonial

We would appreciate your helping others evaluate weight loss surgery as an option for treating their morbid obesity. Personal experiences from other patients are just as important sometimes as scientific publications when making this decision.

General Instructions

• Print this PDF file, complete and return to us. Click to print: (Be patient, it may take some time to load)
• You may include up to two pictures – preferably e-mail them to us as digital images, however you may include photographs that we can copy and return to you. We can use your clinic pictures if they are satisfactory and if you wish. We would e-mail you a copy to approve before using.
• Please use the following pages to structure your comments. These are only suggestions – feel free to freelance as well.
• Your submission will be reviewed and possibly edited by the Duke WLS Program. If edited, it will be returned to you for your approval before being used on the web site.
• Depending on web site space, your submission may or may not be used. If we receive a lot of submissions, we will most likely periodically rotate those used on the web site.
• You must fill in, sign, and return the attached Authorization for Release of Information and/or Photo form. We will give you a copy after we sign it.

  Thanks again…

Click on name to read testimonial