Weight Loss Surgery New Patient Application

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Thank for your interest in the Duke Weight Loss Surgery program.

Please complete this application to start the process. You will need your health insurance information and your primary care provider’s phone number to complete the form. All the information you provide on this secure site will be kept confidential, and will only be used by Duke Health to support your application.

Visit our weight loss surgery webpages to learn about our program, our weight loss surgeons, and if you're eligible for weight loss surgery.

Have you ever been a patient in the Duke system?*
Leave blank if you do not know.
Are you interested in bariatric surgery or medical (non-surgical) weight loss options?*
Have you previously had either bariatric surgery or a Nissen Fundoplication (a common treatment for GERD/reflux)?*
Are you seeking another bariatric procedure?
Was your previous surgery at Duke?
Are you currently experiencing a complication of your bariatric surgery or Nissen Fundiplication?
Which surgeon would you prefer?
Appointments are available in Durham for all surgeons.
1Appointments also available in Raleigh.
2Appointments also available in Burlington.
Which office location would you prefer?*
How did you hear about us?*