Can I complete my application online?

Optional online registration

Would you like to get started now? You can download and complete our application forms before your consolation.

  1. Watch our presentation here.

    Print and sign the Certificate of Completion.

  2. The following forms may be submitted online.

    Patient Contract
    Patient Advisory Form
    Patient Information Form

  3. The Health Assessment Questionnaire may be mailed or faxed to our office.

    Health Assessment Questionnaire

    Fax to:
    ECU Bariatric Surgery at 252-744-3469

    or Mail to:
    ECU Bariatric Surgery Office
    517 Moye Blvd, First Floor
    Greenville, NC 27834

  4. Fill out and bring these forms to your consultation.

    Dietary Weight Loss Attempts
    Exercise Weight Loss Attempts
    Weight History Requirements

We look forward to seeing you for your consultation. Our office is at 517 Moye Boulevard. You can reach us at 252-744-2018 or by email at weightlosssurgery@ecu.edu.