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Share Your Success - Reconstructive and Cosmetic Surgery

You made the decision to take your quality of life to the next level with reconstructive or cosmetic surgery following your weight loss. Now's your chance to share some personal advice that may help someone else. 
 
Please answer each question and send conservative before and after photos. Tight fitting clothing works well for this purpose. 

Email pictures to: 

Mail pictures to: 
Barix Clinics
Marketing Department
135 S. Prospect
Ypsilanti, MI  48198
Attention:  Share Your Story

CHECK THOSE THAT APPLY: 
I am emailing before & after pictures
I am mailing before & after pictures

CONTACT INFO

FIRST NAME
 * required
LAST NAME
 * required
MAILING ADDRESS
 * required
CITY
 * required
STATE
 * required
ZIP CODE
 * required
DAYTIME PHONE (XXX-XXX-XXXX)
 * required
EMAIL ADDRESS
 * required

GENERAL INFO

TYPE OF RECONSTRUCTIVE/COSMETIC PROCEDURE:
 
IF OTHER: 
SURGERY DATE (MM/DD/YYYY)

   

  

WHAT LED YOU TO CONSIDER SURGERY?
(Medical problem, clothing, difficulty exercising, self-esteem, etc) 

  

HOW DID YOU RESEARCH THE SURGERY?
(Online, friends, consultations, etc) 
WHY DID YOU CHOOSE BARIX CLINICS?
DESCRIBE YOUR EXPERIENCE?
(Consultation, surgery, hospital stay, follow up care)
DESCRIBE YOUR LIFE AFTER SURGERY: 
(Consider your health, clothing, activities, confidence, etc.) 

Terms & Conditions:

I have read and agree to the terms above
I do not agree to the terms above

                                              

Our privacy pledge: 
We respect your privacy.  We only ask for this information to help Barix Clinics communicate the message about our program to others.  Rest assured that your personal information will be kept in the strictest confidence and we will not share this information with any non-affiliated third parties-that means it will only be used for Barix advertising. 

Questions:  Contact Marketing at 800-282-0066

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