Companion Form – Blossom Bariatrics

⚠

Please share this with your companion: Companion Requirements

Your companion must be over the age of 18 and be able to:

Walk 200 feet without shortness of breath or chest pain, and without the assistance of a walker,
cane, wheelchair or the use of additional oxygen
Lift 25-50 pounds
Stay with you the day/night of surgery through the following morning
Call the surgeon in the event of an emergency
Track your medications and ensure you are adhering to the aftercare instructions provided
Attend the Companion Class at the hotel the day of your initial appointment or your EGD
appointment

YOUR First Name *

YOUR Email *

Companion Name *

Companion Phone *

I understand that I am required to bring ONE adult companion, age 18 or older, with me for the entire duration of my procedure, and that my companion is physically capable of caring for me. *

I would like information on available companion services (for those who may not have a companion available.)

Need help or have any questions?

Reach out to your coordinator directly or give us a call at 855-BLOSSOM.

Please Submit Your Companion Info Below