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Registration Form

Thank you for your interest in the Illinois Bariatric Center. Should surgery be the best approach to managing your weight, we guarantee our commitment to personalized and quality care. Our physicians, nurses, dieticians and staff prepare patients carefully before surgery. We believe this comprehensive preparation helps us meet your expectations after surgery.

It is crucial that you complete the personal health data in our Registration Form. Please download the form, carefully complete it, and send it to us.

Illinois Bariatric Center Patient Registration Form
(Right click to download)



1. Download the PDF, and save it to your computer.

2. Open the PDF with your Adobe PDF program and begin typing information into the fields.

3. When you are finished, save the file.

4. Send an email with your completed PDF attached, to: beth@illinoisbariatric.com

If you have any questions or issues, feel free to contact us!