Obesity Surgery Center of Monterrey

The best solution to your weight problem may be gastric bypass surgery or the adjustable gastric band. Throughout the US, Canada and Latin America, people suffering from severe obesity are finding a long-term solution with Dr. Rumbaut. To begin the process of determining if weight loss surgery, whether the adjustable gastric band or gastric bypass, is the most appropriate course of action for your particular circumstances, please fill out and submit the form below.

PLEASE NOTE: The United States State Department is changing its rules regarding international travel. As of December 31, 2006, you will only be able to use a passport for traveling to Mexico. Please plan ahead for your trip!

*required fields for those interested in the lapband
and the gastric bypass surgical procedures

First Name*:
Last Name*:
E-mail*:
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Address*:
City*:
State/Province*:
Zip*:
Country*:
Date of Birth*:
Sex*:
Language*:
Phone Number*:
Surgery*:
Height*: ft in OR m cm
Weight*: lb OR kg
Occupation:

Family Obesity History

Parent:
Sibling:

Medical History
Choose all that apply in each category.
To select multiple options use the CTRL key.

Cardiovascular:
Respiratory:
Gastrointestinal:
Dentures:
Gynecological:
Endocrine:
Psycho/Social:
Joint Pain:
Arthrosis:
Other Diseases:
Other Diseases (list):
Drugs:
Alcohol drinks/day:
Medications Prescribed:
Medications Self-Administered:
Allergies - Food:
Allergies - Medicine:

Diet History

Previous Diets:
When:
Weight Loss:
Weight Regained:
Timeframe for Surgery:
Financing Interest:
How did you hear about us?:
Other Information:



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MedChoice Financial

MedChoice Offers:

  • Credit Limits from
    $500 to $25,000*
  • Low Monthly Payments
  • No Pre-Payment Penalties
  • No Annual Fees
  • No Payments or Interest
    Plans for 3, 6 or 12 Months!
  • Online Account Info
  • Bill Pay
  • Authorized User Feature
    which allows your Family
    or Friends to use the
    Account without having
    to Reapply

    To maximize ALL approval options for your treatment please complete the follow steps:
        1.  Call 800.358.8980
                 (Option 1).
        2.  Identify Provider Id
             # 4618 or Provider Name
             - Dr. Roberto Rumbaut
        3.  Receive an answer
             within minutes

     

Punto Central Building
Avenida de la Industria No. 300
C Tower, First Floor, No. 8
Fracc. Desarrollo Punto Central
San Pedro Garza Garcia, C.P. 66279
 Tel: (52-81) 8347-4481 or
 (52-81) 8333-6891
 Fax: (52-81) 8347-4481