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DO YOU NEED A FILL?

If you have not loss the weight you want, you might need a fill. A fill helps adjust the band to restrict your eating to about a third of your normal intake.

Please fill the form with your information to schedule a lap band fill at MEDIQ'S Center (Tijuana, Mexico).

Please, provide the following information so we can provide you a better service.

When filling this form you will be contacted by one of our representatives and confirmed your appointment.

   
Name:
mobile telephone:
home telephone:
e-mail:
alternative e-mail:
Date for the fill:
arrival date:
arrival time:
: hrs
airline:
flight number:
Who is your patient coordinator :
Comments:
 


Before & After

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Mary Testimonie

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Hilary Branch

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