Please complete the form below and our team will be in touch with you promptly. Have you had previous weight loss surgery?* Yes No Because you've had weight loss surgery before, please contact your GP or previous surgeon to discuss whether you are suitable for further weight loss surgery, before requesting a consultation at Sea Change.What is your age (in years)?*Because of your age, please contact your GP to discuss whether you might be suitable for weight loss surgery before requesting a consultation at Sea Change.What is your height (in cm)?*What is your weight (in kgs)?*Your body mass index (BMI)At your current BMI, you are unlikely to be suitable for weight loss surgery. Please see your GP to discuss other options.You are most likely eligible for our Saxenda® Program (medication) and/or an Intragastric Balloon (this is a non-surgical procedure). Our staff will contact you to book in your consultation at Sea Change.You may be suitable for weight loss surgery. Please complete your further details below and our staff will contact you to book in your consultation at Sea Change.You’re highly likely to be suitable for weight loss surgery. Please complete your further details below and our staff will contact you to book in your consultation at Sea Change.Which of our specialist doctors would you like to see?* Next available Dr Gately Dr McLeod Your name* First Last Email address* HiddenDate DD slash MM slash YYYY HiddenPhone number*Phone number* What's the best time for us to try contacting you?*We will do our best to try to contact you at your preferred time, but please understand if that's not possible.Select..8:00-8:59 am9:00-9:59 am10:00-10:59 am11:00-11:59 am12:00-12:59 pm1:00-1:59 pm2:00-2:59 pm3:00-3:59 pm4:00-4:59 pm5:00-5:59 pmDo you have a referral from your GP or other specialist?*You do not need a referral to book your consultation. You'll just need one before you attend our clinic for your consultation. Yes No
