To be evaluated, Dr. Hansen needs the following forms completed. This will save you time in the office an make your visit more efficient.
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Fill out your Registration and the Health History by clicking each of the links to place your information into our system. The Health History link will generate an email that you should immediately send. Filling out these sections will eliminate a lot of the usual paperwork when you come into the office which will make your visit more efficient.
If you are unable to send these forms you can print them and fax them to us or bring them to our office.
This information will be placed in your electronic medical record to significantly lessen paperwork on your visit. If you can not complete these online you can print these and bring them with you.
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Credentialed: The practice has completed Lap-Band® Training and Proctoring and/or ReShape Lifesciences™ continuous education training within the past 24 months.
High-volume Center: The practice has completed Lap-Band® Training and Proctoring and/or ReShape Lifesciences™ continuous education training within the past 24 months.
Premier Center: The practice has completed Lap-Band® Training and Proctoring and/or ReShape Lifesciences™ continuous education training within the past 24 months. The practice has performed 250+ Lap-Band® Procedures over the last three years.