The Duodenal Switch

Patient Follow-up

It is important to all patients and for us to have good follow-up and care.  We are trying to
keep a long term  record of all our Duodenal Switch Patients.  We would like to know how
you are doing, your current weight, are you taking vitamins, calcium, etc.  Are you satisfied
with the surgery?  Have you had more surgery for any reason since we last heard from you?
All information will be kept private and used only to keep statistics.
Below is a form we would like you to complete including your current address, phone
number, name (some have changed), your ACL number if you know it.  And, the name,
address and phone number of any other patient that has had surgery by  Dr. Hess or
Dr. Oakley.
Patient Name
* Required Information          
Your Name*
Name at time
of surgery
(if different)
ACL #
(if you know it)
Current Address*
Street:
City: State:
Zip Code:
Phone Number*
Email Address
Current Weight* Pounds
Are you taking vitamins?* Yes
No
Are you eating good protein?* Yes
No
What Calcium are you taking?*
Someone who knows how
to find you if you move?
Name:
Street:
City: State:
Zip Code:
Phone:
Others you know who have
had this surgery by us?

We need your help!     
Name:
Street:
City: State:
Zip Code:
Phone:

Name:
Street:
City: State:
Zip Code:
Phone:
If you are having trouble let us know...
Mail to: Dr. Hess
1362 Conneaut Ave.
Bowling Green, OH 43402
OR
Describe here...