Physicians / APPs Only
|
Employees Only
Click here for more info
on Coronavirus (COVID-19), vaccines, and visitor restrictions.
Click here for more info
on Coronavirus (COVID-19), vaccines, and visitor restrictions.
MENU
Jobs
Job Listings
Physician Opportunities
Nurses
Volunteer
Find a Physician
Employed Physicians
All Physicians
Patient & Visitor Info
Visitor Info
Baby Gallery
Bill Payment
Directions
Financial Assistance
Gift Shops
Health Calendar
Medical Records
MyChart
Nominate a Star
Patient Price Info
Patient Relations
Pharmacy
Pre-Registration
Request a Prayer
Scheduling Questions
Send an eCard
Spiritual Services
Support Groups
Thank a Nurse
Volunteering
Worker's Comp
Health Services
Emergency
Brain, Spine, Stroke
Cancer Care
Heart and Vascular
Orthopedics
Sports Medicine
Maternity
Mental Health
Weight Loss
See All >>
Locations
Hospitals
Emergency
Urgent Care
Cardiac Diagnostic
Digital Mammography
Lab
Outpatient Rehab
Pharmacy
Radiology
Sleep Centers
Sports Medicine
Wound Centers
See All >>
About Us
About KHN
Leadership
Mission & Vision
Community Health
Kettering History
Charles F. Kettering
Awards
Directions
Media Room
Resource Library
Ways to Give
Education
Advanced Practice Providers
BLS/ACLS Renewals
Continuing Medical Education (CME)
Kettering College
Kettering Medical Education
Grandview Medical Education
Soin Medical Education
Nurse Residency
Pharmacy Residency
Billing
Contact Us
Kettering Health Network (ketteringhealth.org)
Health Plans
Directions
Request a Prayer
Send an eCard
Ways to Give
×
Outpatient Scheduling Questions
Where is my procedure?, What time is my procedure?, Are there any specific preparations?, Can I change the date and time?... Or any other questions related to your already scheduled procedure.
This form is NOT for initial scheduling purposes.
If you need to schedule an outpatient procedure, please call
(937) 384-4510
.
* Patients Name:
* Your Email:
* Patient's Doctor:
* Question:
Weight Loss
A-
A
A+
Text Size
Weight Loss Solutions
Weight Loss Program
Weight Loss Surgery
-
Procedures
-
Doctors
-
Financial Info
-
FAQs
-
Seminars
-
Testimonials
Support Groups
Locations
Bariatric Library
Weight Loss Solutions
Weight Loss Program
Weight Loss Surgery
Procedures
Roux-en-Y
Sleeve
Biliopancreatic
Doctors
Financial Info
FAQs
Seminars
Testimonials
Jessica
Margaret
Support Groups
Locations
Bariatric Library
Online Seminar Registration Form
The online seminar will take about 45 minutes. Before you fill out the form below, make sure you have set aside enough time to complete.
First Name
Last Name
Address
City
State
AK
AL
AS
AZ
AR
CA
CO
CT
DE
DC
FM
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MH
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PW
PA
PR
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
WY
Zip
Phone
(xxx-xxx-xxxx)
Email
Date of Birth
Height
Feet
Inches
Weight
Pounds
Physician
Insurance
How You Heard About This?
TV
Radio
Newspaper
Web
Mail
Phone Book
Family / Friends
KHN
Community Event
Facebook
Physician
Other
Please Tell Us
Physician Name
Please Tell Us What KHN Community Event
Have you had previous bariatric surgery?
Yes
No
Have you registered for a seminar before?
Yes
No
All information gathered from this form will not be sold to or used by any third party.
Patients & Visitors
Visitor Info
Baby Gallery
Billing
Directions
Financial Assistance
Find a Physician
Gift Shops
Medical Records
MyChart
Patient Price Information
Patient Relations
Pharmacy
Pre-Registration
Request a Prayer
Scheduling Questions
Send an eCard
Spiritual Services
Support Groups
Thank a Nurse
Volunteer
Worker's Comp
Health Services
Brain, Spine & Stroke
Breast Health
Cancer Care
Emergency
Heart and Vascular
Maternity
Mental Health
Orthopedics
Sports Medicine
Weight Loss
See All >>
Jobs
Job Listings
Physician Opportunities
Nurses
Volunteering
Locations
Hospitals
Emergency
Urgent Care
Cardiac Diagnostic
Digital Mammography
Lab
Outpatient Rehab
Pharmacy
Radiology
Sleep Centers
Sports Medicine
Wound Centers
See All >>
Education
Advanced Practice Providers
BLS/ACLS Renewals
Continuing Medical
Education (CME)
Kettering College
Med Ed - Kettering
Med Ed - Grandview
Med Ed - Soin
Nurse Residency
Pharmacy Residency
Network Information
About Us
Kettering:60
Media Room
Resource Library
Privacy Practices
Terms of Use
Access
Physicians Only
Employees Only
Vendors Only
Kettering Care Continuum Only
© 2021 Kettering Health
All Rights Reserved.
Connect With Us
Ways to Give
Contact Us
Facebook
Linkedin
YouTube