Please watch the orientation video and complete the form below.

For any questions, contact Teresa Highley, Bariatric Program Coordinator
Phone: (703) 689-9328 or Email Teresa Highley

All fields with an asterisk (*) are required.

Thank You

The form was submitted successfully.

2020-CAP-Reston Hospital-Bariatric Orientation Webinar-PI
Name*
Date*
Date of Surgery *
Do you certify that you watched the orientation video in its entirety?*