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1. Name:

2. City and state:Brisbane, Queensland, Australia

5. Are you: Considering Surgery, Pre Op or Post Op: I have a Lap-Band

and am considering furthur surgery.

6. Date of WLS:6/6/05

8. Type of Surgery:Lap-Band

9. Highest Pre Surgery Weight:249lb (current 207lb, 5'2 " )

10. Insurance or self pay:Insurance(It works a little diffrently in

Australia)

11. What is the name of your insurance company that covered your WLS:

HBA

12.Birthdate:19/12/74

13.Occupation:Teacher

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