To send us your story about weight loss surgery at Duke:

• Print this PDF file (66 KB), complete and return to us. 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.

Thank you for your help.