In-Person Seminar Registration

Please complete the form to register for an upcoming Weight Loss Surgery in-person seminar. The seminar will be held in the Hannibal Regional Conference Center which is located inside the Hannibal Regional Medical Group main entrance.

First Name *

Last Name *

Date of Birth: *

Phone Number *

Email Address *

Mailing Address: *

City: *

State: *

Zip Code: *

I am interested in learning more about: *

Medical options for weight loss.

Surgical options for weight loss.

Undecided.

If you are ONLY interested in learning more about medical weight loss options offered by Hannibal Regional Weight Management Solutions, seminar attendance is not required (this is information about bariatric surgery exclusively). Please complete this form in its entirety and submit; a member of our team will reach out to you very soon to discuss next steps.

If you are ready to proceed with an appointment with our medical weight loss provider, please click the "Get Started - Medical Weight Loss" button on our website to complete your New Patient Health History form. Upon completion, this will be securely transmitted to our office and a member of our team will contact you to schedule an initial evaluation.

Thank you for choosing Hannibal Regional Weight Management Solutions!

If you are interested in learning more about surgical options offered by Hannibal Regional Weight Management Solutions, you're on the right track! Attending an online or in-person seminar will help answer your questions and is a step toward scheduling your initial evaluation with one of our highly skilled surgeons.

You are registering for an in-person seminar. To expedite the process, we will be sending you an email with the link to our New Patient Health History form. Upon completion, this will be securely transmitted to our office. Alternatively, a paper copy of the form is available - contact our office prior to your seminar date to have this emailed, mailed, or ready for pick-up. Having the New Patient Health History completed prior to your seminar date will allow you to schedule an initial appointment at the conclusion of the seminar.

If you would like to expedite the intake process, please return to the main webpage and click the "Get Started - Bariatric Surgery" button to view our online seminar and complete your New Patient Health History form. When we receive the information in our office, a member of our team will reach out to you right away to schedule your initial evaluation.

Thank you for choosing Hannibal Regional Weight Management Solutions!

If you are undecided about which option is best for you, attending an in-person or online seminar is a great place to start. You will learn about the surgeries offered by Hannibal Regional Weight Management Solutions, the rationale behind choosing surgery, and the risks, benefits, and alternatives to surgery in an effort to help you make an informed decision.

If you would like to expedite the intake process, you may view our bariatric surgery seminar online; please return to the main webpage and click the "View Seminar Online" button.

If this helps you make a decision, great! You may then choose to utilize the "Get Started" options on our main page to complete the appropriate New Patient Health History form. When we receive the information in our office, a member of our team will reach out to you right away to schedule your initial evaluation with a surgeon or our weight management provider.

Thank you for choosing Hannibal Regional Weight Management Solutions!

Select the date you plan to attend *

How did you hear about our program? *

Name of Healthcare Provider: *

Which radio station? *

Please explain: *

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