Please watch the orientation video and complete the form below. For any questions, contact Roz Barron, Bariatric Program Coordinator Phone: (703) 689-9328 or Email Roz Required fields are marked with an asterisk *. First Name *Last Name *Phone Number *Email *Date *Date of Surgery *Do you certify that you watched the orientation video in its entirety? * CertifiedQuestions Rate Your Experience Submit SuccessThe form was successfully sent. There was an error with the form submission.