Small Font Regular Font Large Font
Print This Page
 
Johns Hopkins Center for Bariatric Surgery

Request a Stomaphyx™ Consultation


** Please Note: This consultation request form is for patients who have already had bariatric surgery and are interested in the StomaphyX procedure. All other patients must register for an Information Session. DO NOT USE THIS FORM IF YOU HAVE NEVER HAD BARIATRIC SURGERY. **
Please be aware that StomaphyX is currently not a covered benefit for any insurance providers. The out-of-pocket cost for this procedure is approximately $9,000.00.
All fields marked with << are required. Your form will not be submitted without this data.
MM/DD/YYYY
Calls are made between 8:00 am and 4:00 pm, Monday through Friday. Please provide a number where we can reach you during that time.
Preferred Contact
If you answered "Other", please describe.
Gender
(Location, type, surgeon, year)
Health Conditions
I'd Like to See
We are finding that most insurance companies don't cover the StomaphyX procedure. Please verify your benefits in advance if you do not wish to pay for the procedure out of pocket.
** PLEASE NOTE: If your insurance company requires a referral, we CANNOT schedule your appointment until our office has received your referral. **
Fields marked with « are required.
 
 
 
Featured In
 
 

 
For Employees | Legal | Site Map

Help us help you...

Recent Recognitions
   Commission on Cancer

Ranked among the "Best" in Geriatrics, Endocrinology and Respiratory!

 
 
How useful was this information?
Very
Not at all
How easy was it to find?
Very
Not at all
 
 
 
 

Copyright © 2008 Johns Hopkins Bayview Medical Center

4940 Eastern Avenue. Baltimore, Maryland 21224. 410.550.0100