Patient Registration

Thank you for beginning the initial registration process, we are excited to have you as a patient! You have taken the first step in your weight loss surgery journey, and remember, we will be by your side to help you through the entire process.

You now have two options in this initial registration process:

Online Pre-Registration Form

If you simply desire to know if you are a candidate for weight loss surgery or if your insurance company will pay for such a procedure, you can complete the initial "Pre-Registration Form" and our office will be in contact with you over the next few days. Upon completion you may return to the web site homepage to continue browsing and gathering information.

Download Complete Registration Form

If you are ready today, you can proceed to “Complete Registration” and finish the entire registration process. After downloading and completing the registration form, email the completed form to Someone from our office will then contact you to schedule an initial consultation with Dr. Bellanger.

Download Complete Registration Form

The reason for the extensive registration process is to collect health and diet information for your medical record. This information will be used to determine eligibility for surgery and any important health information regarding obesity related medical conditions.


Weight Loss Surgical Centers
of Louisiana

16851 Jefferson Hwy
Suite 3A
Baton Rouge, La 70817

phone 225.771.8741
fax 225.771.8746


Information on this website represents general medical information from various sources and may not represent the actual practices of Dr. Bellanger.
Please consult your surgeon for more specific information.