Tell Us Your Story

Maybe it was when you knew the diets weren’t working. Perhaps it was a referral from your physician. Or, you were inspired by a friend.

Whatever set you on your path to bariatric surgery, Premier Metabolic and Bariatric Associates wants to hear about your weight loss journey, from your first appointment to your new life after surgery. Your story may be chosen to appear on our website and social media pages.

Complete and submit the form below. If chosen, you’ll be contacted by a Premier Physician Network representative to schedule an interview and possible videotaping or photography.

Please call Premier Metabolic and Bariatric Associates at (937) 208-5300 if you have any questions.

 * First Name:  
 * Last Name:  
 * Email Address:  
 * Best phone number during business hours:  
 * Date of surgery:  
 * Surgeon:  
 * In a few sentences, tell us how weight
    loss surgery has changed your life: