Information contained in this website is provided for educational purposes only. It is imperative that you consult your own physician regarding the application of any opinions or information presented in this website or received in any e-mails from WEIGHT LOSS TEAM. It is not intended to replace the advice of a medical professional or in any way to be prescriptive. The author and website administrator has used sources believed to be reliable in efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. Medical knowledge changes rapidly. In lieu of the possibility of human error and changes in medical science, neither the author or website administrator, nor any party who is involved in the preparation or publication of these works or e-mails warrants that the information contained is in every respect accurate or complete, and they are not responsible for any errors or omissions or for the results obtained from the use of such information. Readers and website users are strongly encouraged to discuss and confirm the information contained in the website and e-mails with their own physician. People who use this website do so with the understanding that the author, publisher, website administrator, WEIGHT LOSS TEAM, any staff member or owner, and any and all other contributors, shall have neither liability nor responsibility to any person or entity with respect to any loss or damage caused or alleged to be caused directly or indirectly by the information contained in this website or the e-mails sent from WEIGHT LOSS TEAM.
It is your responsibility to verify whether or not your insurance covers any type of surgery you will be having with Dr. Juan Francisco Hidalgo. Dr. Hidalgo does not accept any insurance for payment of surgeries rendered in Mexico. It is further your responsibility to verify with your insurer and the CMQ Premiere Hospital in Puerto Vallarta, whether or not your insurance will cover any complications you may have as a result of going to Mexico for surgery. It is also recommend that you call your insurance provider to ascertain what coverage is available to you for both Emergency and Non Emergency situations you may be presented with when traveling outside of the United States and furthermore it is advised that you familiarize yourself with your own insurance policy and their methods rules and regulations on how to make an insurance claim when traveling abroad for both medical emergencies and non emergencies. Complications may arise during surgery some of which may or may not be covered by your insurance company, it is your responsibility to be fully informed before going to Mexico.
All materials contained in any part of the Weight Loss Team website or Support Group website is the copyrighted property of Weight Loss Team, hereinafter referred to as, Weight Loss Team or its subsidiaries or affiliated companies and/or third-party licencors. All trademarks, service marks, trade names, and trade dress are proprietary to, Weight Loss Team, or its affiliates or licensees. No material from any part of this website or any Internet site owned, operated, licensed, or controlled by us may be copied, reproduced, republished, uploaded, posted, transmitted, or distributed in any way, except that you may download one copy of the materials on any single computer for your personal, noncommercial home use only, provided that (i) you keep intact all copyright and other proprietary notices, (ii) you make no modifications to the materials, and (iii) you do not use the materials in a manner that suggests an association with any of our products, services, or brands. The use of any Weight Loss Team material on any other Web site or computer environment is expressly prohibited.
We are pleased to hear from our visitors and welcome your comments regarding Dr. Hidalgo’s procedures and Weight Loss Team’s services.
If, through participation in certain activities, you send any material (e.g., postings to chat, boards, emails or contests) or, despite our request, you send us unsolicited creative suggestions, ideas, notes, drawings, concepts, or other information (collectively, the “Submissions”), the Submissions shall be deemed, and shall remain, our property. None of the Submissions shall be subject to any obligation of confidentiality on our part and we shall not be liable for any use or disclosure of any Submissions. Without limitation of the foregoing, we shall exclusively own all now-known or hereafter existing rights to the Submissions of every kind and nature throughout the universe and shall be entitled to unrestricted use of the Submissions for any purpose whatsoever, commercial or otherwise, without compensation to the provider of the Submissions or any other person or entity.
“Forum” means a chat area, message board, support group, instant messaging, mobile messaging or e-mail function (including, but not limited to, electronic greeting cards) offered as part of any Weight Loss Team, Site. If you participate in any Forum within a Weight Loss Team Site, you agree to follow our terms set forth below.
You acknowledge that anything you submit to a Weight Loss Team. Site by way of any Forum is routed through Weight Loss Team hosting servers and the Internet and that, therefore, you have no expectation of privacy with regard to any such submission. You acknowledge that the Forums and features on Weight Loss Team Sites are forums for public and not private communications. Please keep in mind that whenever you give out personal information online, for example, via message boards or chat, that information can be collected and used by people you don’t know. We cannot guarantee the security of any information you disclose online; you make such disclosures at your own risk.
Users or visitors shall remain solely responsible for the content of their messages in the Forums. We are not responsible for the content or opinions posted or sent by users in any Forum. You take responsibility for postings under your username and use the information provided in the Forums at your own risk. We reserve the right to remove or edit content from any Forum at any time and for any reason although we have no duty to do so.
When participating in a Forum, never assume that people are who they say they are, know what they say they know, or are affiliated with whom they say they are affiliated with in any chat room, message board, or other user-generated content area. Information obtained in a Forum may not be reliable, and it is not a good idea to take any action, including to trade or make any investment decisions, based solely or largely on information you cannot confirm. We cannot be responsible for the content or accuracy of any information, and shall not be responsible for any trading, investment, or any other decisions made based on such information.
The following is a list of the House Rules of conduct for any Weight Loss Team Site. By using the Weight Loss Team Sites you agree not to do any of the following:
Post, distribute, or otherwise make available or transmit any data, text, message, or computer file that we deem to be: (a) defamatory, abusive, harassing, insulting, threatening, or that could be deemed to be stalking; (b) bigoted, hateful, or racially offensive; (c) vulgar, obscene, or sexually explicit (language or images); or that (d) encourages or advocates illegal activity or the discussion of illegal activities with the intent to commit them;Post, distribute, or otherwise make available or transmit any data, text, message, computer file, or other material that infringes and/or violates any right of a third party or any domestic or international law, rule, or regulation, including but not limited to: (a) copyright, patent, trademark, or other proprietary rights; (b) right of privacy (specifically, you must not distribute another person’s personal information of any kind without their express permission) or publicity; (c) any confidentiality obligation; Advertise or sell any products, services or otherwise (whether or not for profit), or solicit others or use any Forum for commercial purposes of any kind,Post, distribute, or otherwise make available or transmit any software or other computer files that contain a virus or other harmful component; Impersonate any person or entity or misrepresent your identity or affiliation with any person or entity; Engage in antisocial, disruptive, or destructive acts, including “flaming,” “spamming,” “flooding,” “trolling,” and “griefing” as those terms are commonly understood and used on the Internet; Delete any legal notices, disclaimers, or proprietary notices such as copyright or trademark symbols, or modify any logos that you do not own or have express permission to modify; Post, distribute, or otherwise make available or transmit material or make statements that do not generally pertain to the designated topic or theme of any Forum.
We reserve the right to remove any material, and if we deem appropriate, to turn over to law enforcement officials, any material, including message, e-mail, or posting, that is in violation of these House Rules. We also reserve the right to remove messages, e-mails, or postings that do not pertain to the designated topic or theme of the Forum.
We make no representations concerning the content of sites listed in any of our directories. Consequently, we cannot be held responsible for the accuracy, relevancy, copyright compliance, legality, or decency of material contained in sites listed in our search results or otherwise linked to a Weight Loss Team Site.
THE MATERIALS IN THE Weight Loss Team SITES ARE PROVIDED “AS IS” AND WITHOUT WARRANTIES OF ANY KIND, EITHER EXPRESS OR IMPLIED. TO THE FULLEST EXTENT PERMISSIBLE PURSUANT TO APPLICABLE LAW, WE DISCLAIM ALL WARRANTIES, EXPRESS OR IMPLIED, INCLUDING, BUT NOT LIMITED TO, IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE AND NON-INFRINGEMENT. WE DO NOT WARRANT THAT THE FUNCTIONS CONTAINED IN THE MATERIALS ON ANY Weight Loss Team SITE WILL BE UNINTERRUPTED OR ERROR-FREE, THAT DEFECTS WILL BE CORRECTED, OR THAT ANY Weight Loss Team SITE OR THE SERVERS THAT MAKE SUCH MATERIALS AVAILABLE ARE FREE OF VIRUSES OR OTHER HARMFUL COMPONENTS. WE DO NOT WARRANT OR MAKE ANY REPRESENTATIONS REGARDING THE USE OR THE RESULTS OF THE USE OF THE MATERIALS ON ANY Weight Loss Team SITE IN TERMS OF THEIR CORRECTNESS, ACCURACY, RELIABILITY, OR OTHERWISE. YOU ASSUME THE ENTIRE COST OF ALL NECESSARY SERVICING, REPAIR, OR CORRECTION. APPLICABLE LAW MAY NOT ALLOW THE EXCLUSION OF IMPLIED WARRANTIES, SO THE ABOVE EXCLUSION MAY NOT APPLY TO YOU. Weight Loss Team PROVIDES TRAVEL RELATED SERVICES AND SCHEDULING INFORMATION PERTAINING TO WEIGHT LOSS SURGERY IN MEXICO. NEITHER WEIGHTLOSSTEAM.COM, WEIGHT LOSS TEAM, NOR ANY OF ITS STAFF, REPRESENTATIVES, PROMOTERS, OR AGENTS ARE EMPLOYEES OF DR. HIDALGO, ALL OF WHO IS SOLELY LICENSED TO PRACTICE MEDICINE IN THE STATE OF JALISCO, NAYARIT, IN THE COUNTRY OF MEXICO. WEIGHTLOSSTEAM.COM, WEIGHT LOSS TEAM, ANY OF ITS STAFF, REPRESENTATIVES, PROMOTERS, OR AGENTS, AS WELL AS THE WEBSITE WEIGHTLOSSTEAM.COM SOLELY PROVIDE REFERENCES FOR DR. HIDALGO, AND ACT AS INDEPENDENT COORDINATORS TO ASSIST WITH THE EASE OF ASSISTING PATIENTS WHO PREPARE FOR THEIR PROCEDURES IN MEXICO BY ARRANGING THEIR TRAVEL PLANS AND HOTEL RESERVATIONS. BY USING THIS SITE OR BY YOUR OWN DECISION TO HAVE SURGERY WITH DR. HIDALGO, YOU AGREE TO HOLD HARMLESS WEIGHTLOSSTEAM.COM, WEIGHT LOSS TEAM, ANY OF ITS STAFF, REPRESENTATIVES, PROMOTERS, OR AGENTS FROM ANY AND ALL INJURIES SUSTAINED DURING ANY PROCEDURE EITHER NEGLIGENT, INTENTIONAL OR MALPRACTICE, PERFORMED BY DR. HIDALGO. YOU ALSO HEREBY AGREE TO PAY FOR ANY AND ALL EXPENSES, COSTS AND LEGAL FEES THAT WEIGHTLOSSTEAM.COM, WEIGHT LOSS TEAM, ANY OF ITS STAFF, REPRESENTATIVES, PROMOTERS, OR AGENTS, MAY AND WILL INCUR IF YOU BRING SUIT AGAINST ANY OF THESE NAMED PARTIES OR DR. HIDALGO, IN CASE YOU LOSE THE ACTION. YOU ALSO AGREE TO WAIVE ANY AND ALL RIGHTS TO SEEK ATTORNEY FEES AND COSTS RELATED TO ANY LITIGATION AGAINST WEIGHTLOSSTEAM.COM, WEIGHT LOSS TEAM, ANY OF ITS STAFF, REPRESENTATIVES, PROMOTERS, OR AGENTS. YOU ALSO WILL AGREE TO SIGN WAIVERS AND CONSENT FORMS IN PUERTO VALLARTA, EXPRESSING YOUR ACCEPTANCE TO THESE TERMS PRIOR TO YOUR SURGERY. BY HAVING YOUR SURGERY PERFORMED YOU AGREE TO ANY AND ALL TERMS SET FORTH IN THIS LEGAL PAGE OF THIS WEBSITE AS OF THE DATE ON YOUR RELEASE SIGNED IN MEXICO. WEIGHTLOSSTEAM.COM, WEIGHT LOSS TEAM, ANY OF ITS STAFF, REPRESENTATIVES, PROMOTERS, OR AGENTS, STRONGLY ADVISE YOU TO FULLY RESEARCH YOUR DECISION TO ENTER INTO WEIGHT LOSS SURGERY OR METABOLIC SURGERY AND ALSO ADVISE YOU TO NOT RELY ON ANY INFORMATION PROVIDED EITHER WITHIN THIS WEBSITE OR RECEIVED VIA E-MAIL OR TELEPHONE. FINALLY YOU UNDERSTAND THAT YOU HEREBY AGREE TO SUBJECT YOURSELF TO THE LAWS OF THE COUNTRY OF MEXICO AND BY USING THIS WEBSITE AND CHOOSING TO HAVE SURGERY WITH DR. HIDALGO, YOU HEREBY ASSENT TO SUBJECT YOURSELF TO THE LAWS OF MEXICO FOR ANY AND ALL LAWSUITS OR ARBITRATIONS, NO MATTER WHERE THE SUIT IS BROUGHT. YOU MAY ALWAYS DECLINE TO ALL OF THESE TERMS IN WHOLE BY CHOOSING A DIFFERENT DOCTOR TO DO YOUR PROCEDURE. YOU MAY NOT DECLINE ANY OF THESE TERMS IN PART
Weight Loss Team explicitly disclaim any responsibility for the accuracy, content, or availability of information found on sites that link to or from any Weight Loss Team Site. We cannot ensure that you will be satisfied with any products or services that you receive from Dr. Hidalgo, or any other of the doctors who work on your procedures. We do not make any representations or warranties as to the security of any information (including, without limitation, credit card and other personal information) you might be requested to give any third party, and you hereby irrevocably waive any claim against us with respect to such sites and third-party content. We strongly encourage you to make whatever investigation you feel necessary or appropriate before proceeding with any online or offline transaction with any of these third parties.
IF YOU USE A CREDIT CARD IN MEXICO TO PAY FOR YOUR SURGERY, YOUR FINAL COST MAY BE MORE THAN THE SURGERY PRICE QUOTED ON THIS WEBSITE, AS THE CONVERSION FROM DOLLARS TO PESOS AND THEN BACK TO DOLLARS AGAIN BY THE BANKS AND PARTIES DOING THE TRANSACTIONS MAY RESULT IN THE COST INCREASING A FEW HUNDRED DOLLARS. IF YOU DO NOT WISH TO PAY THESE FEES PLEASE PAY THE DOCTORS WITH EITHER CASH. Weight Loss Team, charges a fee for providing services. This fee is described as a non refundable deposit. This fee is paid by the patient going down for surgery and is in no way paid for by any of the doctors. This fee is for all of the travel related services provided not including your airplane ticket.
You hereby agree to indemnify, and hold Weight Loss Team, and our affiliates and our officers, directors, owners, agents, employees, promoters, information providers, representatives, licencors, and licensees (collectively, the “Indemnified Parties”) harmless from and against any and all liabilities and costs (including reasonable attorneys’ fees) incurred by the Indemnified Parties in connection with any claim arising out of any lawsuit by you for claims arising from your surgery with Dr. Hidalgo. You hereby agree not to bring suit against the “Indemnified Parties” and understand that in no way are the “Indemnified Parties” responsible for any harm which may occur during your Bariatric Surgery. The “Indemnified Parties” reserve the right, to assume the exclusive defense and control of any matter otherwise subject to indemnification by you. If you bring a suit against any of the Indemnified Parties, you are responsible for the Indemnified Parties legal fees, in the case that you do not prevail, and hereby agree to not sue the Indemnified Parties for legal fees in any lawsuit brought by having surgery in Mexico.
UNDER NO CIRCUMSTANCES, INCLUDING, BUT NOT LIMITED TO, NEGLIGENCE, SHALL WE BE LIABLE FOR ANY DIRECT, INDIRECT, INCIDENTAL, SPECIAL, OR CONSEQUENTIAL DAMAGES THAT RESULT FROM THE USE OF, OR THE INABILITY TO USE, ANY WEIGHT LOSS TEAM SITE OR MATERIALS OR FUNCTIONS ON ANY SUCH SITE, EVEN IF WE HAVE BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. APPLICABLE LAW MAY NOT ALLOW THE LIMITATION OR EXCLUSION OF LIABILITY OR INCIDENTAL OR CONSEQUENTIAL DAMAGES, SO THE ABOVE LIMITATION OR EXCLUSION MAY NOT APPLY TO YOU. IN NO EVENT SHALL OUR TOTAL LIABILITY TO YOU FOR ALL DAMAGES, LOSSES, AND CAUSES OF ACTION WHETHER IN CONTRACT, TORT (INCLUDING, BUT NOT LIMITED TO, NEGLIGENCE OR MALPRACTICE), OR OTHERWISE EXCEED THE AMOUNT PAID BY YOU, IF ANY, OR $100 (WHICHEVER IS LESS) FOR ACCESSING OR PARTICIPATING IN ANY ACTIVITY RELATED TO ANY WEIGHT LOSS TEAM SITE.
Weight Loss Team is based solely out of Puerto Vallarta, Mexico. We make no representation that materials on any Weight Loss Team are appropriate or available for use in any particular location in the world. Those who choose to access Weightlossteam.com do so on their own initiative and are responsible for compliance with local laws, if and to the extent local laws are applicable. Those who choose to access Weightlossteam.com agree to accept as a sole and only recourse, legal jurisdiction and court proceedings using the laws of the State of Jalisco in the Courts of the city of Puerto Vallarta and in the state of Jalisco in the country of Mexico for any claims whatsoever that may be had against Weight Loss Team, and any or all of it affiliates including any employees, advocates, coordinators, staff, agents, representatives, and promoters, for any claim except those stated below in the Paragraph entitled GENERAL PROVISIONS. Furthermore you agree that you waive any and all claim of having legal recourse in the US or any other part of the world and accept to the use of the laws of the State of Jalisco, Mexico in the courts of Puerto Vallarta Mexico, to determine the outcome of any legal action. Furthermore you agree that you waive any and all claim of having legal recourse in the US or anywhere else in the world, and accept to the use of the laws of the State of Jalisco, Mexico in the courts of Puerto Vallarta Mexico, to determine and award the amount of damages if a court finds damages wanting in any and all situations. Please note all fees are the responsibility of the party bringing the charges and by using this website you agree to reimburse Weight Loss Team, its agents, representatives, promoters and employees, for any and all legal fees that may or will be occurred in the event of any claim, including but not limited to paying for Weight Loss Team, its agents, representatives, promoters and employees, attorney’s fees and costs, IF YOU DO NOT PREVAIL IN THE PROCEEDING.
Weight Loss Team
PRIVADA BAHIA DE SANTIAGO 156
Parque Las Palmas, Puerto Vallarta Jalisco
Pursuant to Title 17, United States Code, Section 512(c)(2), notifications of claimed copyright infringement must be sent to Service Provider’s Designated Agent.
Notification must be submitted to the following Designated Agent:
Service Provider: WEIGHTLOSS TEAM
Name of Agent Designated to Receive Notification of Claimed Infringement or Service of Process: Gerald Witt
Full Address of Designated Agent to Which Notification Should be Sent: PRIVADA BAHIA DE SANTIAGO 156
Parque Las Palmas, Puerto Vallarta Jalisco
Telephone Number of Designated Agent: (818) 949-6911
E-Mail Address of Designated Agent: email@example.com
To be effective, the notification must be a written communication that includes the following:
A physical or electronic signature of person authorized to act on behalf of the owner of an exclusive right that is allegedly infringed;
Identification of the copyrighted work claimed to have been infringed, or, if multiple copyrighted works at a single online site are covered by a single notification, a representative list of such works at that site; Identification of the material that is claimed to be infringing or to be the subject of infringing activity and that is to be removed or access to which is to be disabled, and information reasonably sufficient to permit us to locate the material;
Information reasonably sufficient to permit us to contact the complaining party, such as an address, telephone number, and, if available, an electronic mail address at which the complaining party may be contacted; A statement that the complaining party has a good-faith belief that use of the material in the manner complained of is not authorized by the copyright owner, its agent, or the law; and A statement that the information in the notification is accurate, and under penalty of perjury, that the complaining party is authorized to act on behalf of the owner of an exclusive right that is allegedly infringed.
SAMPLE TEXT OF INFORMED CONSENT FOR BARIATRIC SURGERY WHICH YOU WILL SIGN ONCE YOU ARE IN MEXICO – Please read the informed consent you receive in Puerto Vallarta before your surgery carefully as the text you sign in Puerto Vallarta may be a little different then the one posted on this website.
Laparoscopic Gastric Sleeve Procedure, Laparoscopic Gastric Bypass Surgery, Lapband, Abdominal Hernia Surgery or any other Bariatric Procedure or Revision.
(To be retained in the patient’s records)
I, ______________ , hereby acknowledge having researched the surgery I am about to undertake. I have viewed and studied comprehensive detailed descriptions and information as well as possible issues related to Bariatric Surgery. I understand that bariatric surgery carries risks and I have done as much research as possible to help me understand these risks. I hereby agree to let any staff member from Dr. Hidalgo’s office or the CMQ Premiere hospital search my luggage and confiscate any item they deem necessary so that I do not eat or drink anything postop that I am not supposed to.
Dated: ______________ Initials:____________
I, ______________ , hereby give my unqualified consent to Dr. Juan Francisco Hidalgo and his staff to perform a Laparoscopic Gastric Sleeve procedure or Gastric Bypass procedure. I certify that I have read about and/or fully been briefed orally by the doctor about the potential risks, benefits, expected outcomes, and medical alternatives of and this surgical procedure, be it the Laparoscopic Gastric Sleeve procedure or Gastric Bypass procedure. I have been provided information and materials, which have allowed me to understand all of the complicated issues, involved in Bariatric Surgery as well as all of what has been stated in this document. I confirm that I have been given adequate time and information to allow myself and my family to make a decision to undergo weight loss surgery. I have reviewed to my satisfaction, all of the relevant issues throughout the process of researching my decision to have surgery. At this time, I confirm that I desire to undergo and proceed with the Laparoscopic Gastric Sleeve procedure or Gastric Bypass procedure or any other bariatric procedure.
Dated: ______________ Initials:____________
RISKS OF OBESITY SURGERY: I recognize that I am severely overweight and meet the criteria for weight loss surgery established by the National Institutes of Health. I understand that this level of obesity has been shown to be dangerous, unhealthy, and to increase my risks of death from a variety of medical illnesses including diabetes, high blood pressure, heart disease, stroke, arthritis, cancer, sleep apnea, and lung disease. I also understand that my risk of death is significantly higher than non-obese individuals. The reason I have chosen to undergo surgery is to help me lose weight so that I can reduce my risk of developing these and other diseases, potentially rid myself of these above mentioned diseases if I suffer from them now, and/or increase my chances to have a normal life expectancy.
Dated: ______________ Initials:____________ PLEASE CONTINUE ONTO PAGE 2
INFORMED CONSENT FOR BARIATRIC SURGERY cont.
It is important that you understand the risks, complications, and changes that may occur with weight loss surgery.
Please verify your acceptance of these risks at the end of the list.
1. Bleeding and the potential need for blood transfusion. Blood transfusion carries the risk of infection with bacteria, parasites, and viruses (Hepatitis, HIV/AIDS)
2. Infection or abscess
3. Poor cosmetic results (you may have a tooth or teeth chipped or broken during intubation or surgery, and Dr. Hidalgo will not be responsible for the cost of repair. Also possible unattractive scar or incision/contour defects)
4. Chronic pain or discomfort
6. Burning or tingling in the incision site or anywhere else in the body
7. Incisional hernia
8. Internal hernia
9. Bowel obstruction/strangulation
10. Atelectasis or lung collapse causing fevers
11. Pneumonia or lung infection including abscess
12. Deep vein thrombosis (blood clot in the vein)
13. Pulmonary embolus (blood clot going to the lung – fatal 30% of the time)
15. Heart Attack
16. Injury to an abdominal or pelvic organ/structure
17. Nausea or vomiting
19. Diarrhea or constipation
20. Heartburn or reflux symptoms
21. Ulcers and/or Gastritis
22. Conversion to an open surgery
23. Failure to lose adequate amount of weight
24. Loss of too much weight
25. Development of malnutrition or vitamin deficiency
27. Development of food intolerance’s
28. Pressure ulcer or decubitus
29. Rhabdomyolysis (breakdown of muscle in the body)
31. Kidney failure and/or need for dialysis
32. Need for ICU care
33. Need for a ventilator
34. Organ failure
35. Development of loose or redundant skin
36. Foul smelling stool and/or gas
37. Need for further or additional surgery to repair a problem
38. Prolonged hospital stay may be needed to treat complications
39. Allergic reaction to medicine/material
40. Reaction to anesthetic
41. Dumping Syndrome
42. Hair loss or thinning
43. Loss of taste
44. Nerve or ligament injury from positioning or lying on the operating table
45. Sterility or inability to become pregnant
46. Increased ability to become pregnant
47. Birth defects or fetal injury if I become pregnant. This is less likely once my weight has stabilized and my laboratory tests are normal. Usually about 2 years after surgery.
48. Post operative depression or other psychological reaction to the surgery
49. Metabolic bone disease (loosing calcium from the bone because of inadequate intake and supplementation) with possible osteoporosis, secondary hyperparathnyroidism, bone fractures.
50. Need to revise or reverse the procedure at some point in the future because of nutritional deficiencies or excessive weight loss or other reasons.
51. Extended disability, financial hardship as a result of complications related to weight loss or surgery.
52. Band slippage
53. Band erosion
54. Obstruction from the band
55. Band or Balloon breakage
56. Need for further or additional surgery to repair a problem, or to repair, replace, or remove the Band.
57. Development of a dilated esophagus or “pseudoachalasia
58. Dysphagia (difficulty or pain with swallowing)
59. Port dislocation, malfunction, leakage, flipping, or disconnection
60. FOR PATIENTS WITH LUPUS: There is an increment in the risk of infection (by 50%) in the area of the surgery and all areas affected by the surgery, as well as dehiscence of the sutures and wounds either immediately or in the future.
Patients Initials: ________
I understand that the above list is not a complete list and other complications not specifically listed here may also occur.
Patient Printed Name: ______________
Patient Signature: ______________
Signed this ____________ day of ____________, 20____ .
Also, I understand that if I do not follow my doctors preop instructions, my medical tourism surgery insurance may be denied by the provider. By not following the preop instructions, I assume this risk.
Weight Loss Options: I understand that there are many options for weight loss. I certify now, that I have tried my best to lose weight using dietary and exercise regimens and have been unsuccessful despite many attempts. I have been informed that weight loss surgery should only be considered as a last resort and after all other non-operative methods have failed. Just as there are many different types of diets, there are also different types of procedures to lose weight. I acknowledge that I am thoroughly aware of my options for surgical weight loss including the advantages and disadvantages of each procedure. I have reached the decision regarding which surgical weight loss procedure is right for me after extensive personal consideration, and have no reservations about my decision at this time.
Acceptance of Surgery: I affirm and understand that the field of weight loss surgery is filled with controversy and that some medical professionals believe that surgery is not appropriate under any circumstance for weight loss. I also understand that long term data on the outcome of surgery for weight loss may e incomplete or inconclusive, but at this time most physicians as well as the National Institute of Health believe that for patients who are considered “Morbidly Obese” and have failed dietary and exercise measures, surgery is the best option for significant and long term weight loss.
Laparoscopic vs. Open Surgery: I understand that my surgical procedure will be performed using a “minimally invasive” approach (either Laparoscopic or Hand-Assisted). I have intentionally chosen this approach because I believe it will cause less pain and scarring, and allow me to leave the hospital quicker. I understand that these techniques are more difficult for my surgeon to perform, and as such, there is a small possibility that it will not be possible to perform my surgery laparoscopically. I am willing to accept the possibility that my surgery will need to be performed “open” using a large incision causing a larger scar, more pain, and a longer hospital stay and recovery time. I also agree to pay the additional fee of $2,000 US dollars in the event the surgery needs to be converted to an open procedure.
Risk of Surgery: I understand that surgery contains risks and complications can occur. I also understand that all surgeons have complications no matter how skilled or talented they are. I understand that by being obese, my risks during surgery are higher than the average person, and that most complications that occur are due to that fact. I have been advised about the extensive and comprehensive risks regarding the complications that are possible during my surgical procedure or as a result of the procedure. I have had the opportunity to ask questions and clarify anything that was not completely clear and/or understood by me. In addition, I was given a listing of potential complications, which I have read in its entirety and fully understand. I am fully aware that if a complication were to occur either during or after surgery, it is my full responsibility to pay for any costs or fees associated with the complication. The amounts are unknown at this time but I hereby agree to pay for any and all costs or fees of any complication arising from my having weight loss surgery.
Blood Transfusion: I understand that surgery can be associated with a significant loss of blood. If this occurs, I realize that I may need to undergo the transfusion of blood products including coagulation factors, platelets, and/or red blood cells. Despite the fact that blood products and donors are screened, infection with bacterial or viral particles is possible from these products. In addition, I understand that transfusion reactions can occur due to antibodies that my system may produce to blood from another individual. I certify that I understand these risks and will accept the transfusion of blood products if my doctor feels they are medically necessary.
Hernia and other procedures: If it is deemed that I have a hernia I consent to the repair of the hernia during surgery. I also consent to any procedure the doctor deems necessary to save my life during this procedure and I hereby agree to pay for the costs related to these procedures.
Revision Surgery: If you have had a lapband, or it has been removed, a prior sleeve or bypass surgery, or any other abdominal surgery, then your current surgery you are having is considered a revision surgery. Revision surgeries can end up costing more than the stated price of the surgery due to unforeseen factors like extra time in the operating room, extra medication, complications and other factors. You hereby agree to pay the hospital directly and prior to discharge, for any additional costs associated with the current surgery taking place and acknowledge the fact that these costs are unknown prior to surgery but may arise due to the fact that the surgery is considered a revision surgery.
Patients Initials: _________
Compliance: I agree to abstain from alcohol and tobacco use, attend support group meetings, attend scheduled follow-up visits, and maintain recommended dietary and exercise regimens. I agree to take every precaution to avoid pregnancy until approved by my physician(s) which may be as much as two years or more after surgery. I understand that even if I have fertility problems in the past, weight loss may make me more fertile requiring birth control during the initial two years after surgery.
Limited Liability and Waiver thereof: Weight Loss Team, its staff, employees, agents, promoters, representatives, are not responsible or liable for any advice, course of treatment, diagnosis or any other information, services or products that you have obtained. I have further been informed that all staff members, representatives, agents, promoters, and/or employees, have nothing to do with the actual procedure of weight loss surgery; all staff members, representatives, agents, promoters, and/or employees only provide a reference and I hereby fully agree to hold any Weight Loss Team staff members, representatives, agents, promoter, and/or employees, other than the actual surgeon, either in whole or in part, free from any and all liability associated with my undergoing surgery with Dr. Juan Francisco Hidalgo, or the hospital that the procedure is done in. I fully accept this waiver of liability by placing my initial on this page or anywhere else in this document.
Patients Initials: _________
Disclosure Statement: I hereby agree to indemnify and hold harmless Weight Loss Team, its staff, employees, agents, promoters, and representatives, against any and all liability, claims, suits, losses, costs and/or legal fees caused by, arising out of, and/or resulting from any negligent act or omission in the performance and/or failure to perform by Dr. Juan Francisco Hidalgo or the CMQ Premiere Hospital, anyone on their staff, under their control or anyone associated with the procedure at hand, or the hospital and its staff and/or anyone under their control. The information provided by Weight Loss Team, its staff, employees, agents, promoters, and representatives, is intended to be a general guide only and its content should be discussed with your local medical practitioner. Weight Loss Team, its staff, employees, agents, promoters, and representatives, shall not be liable for any loss caused, whether due to negligence or otherwise arising from use of or reliance on any and all information provided including the website in general and/ or as a whole. I fully accept the above, by placing my initial on this page or anywhere else in this document.
Photographs/Observers: I agree to allow intra-operative, preop and postop photos or video to be taken of myself or the procedure, which is being performed on me. I agree that these photos/videos may be used for any educational, marketing, scientific or medical purpose. I waive my rights to these images or to compensation for these images. I agree to allow other health care personnel or representatives of surgical or equipment companies to be present in the operating room if requested by my doctor(s). Any images sent or posted to any of Weight Loss Teams Facebook page, email or website of Weight Loss Team postop is covered and included under this paragraph and all rights to these images are transferred to Weight Loss Team and no compensation will be received.
Reproductions: I agree that this form, when signed by me, this document is a legal and binding contract and/or document. Digital reproduction and/or Xerox or Fax copies are considered the same, and are as enforceable as the original Law: I agree that only the laws of the state of Jalisco, located in the Country of Mexico, govern this agreement.
Arbitration: I agree to binding arbitration to settle any medical and or legal disputes and herby waive my right to a jury or court trial for this purpose. I hereby agree that Arbitration will occur in Puerto Vallarta, Jalisco Mexico, using Mexican Laws, and Mexican Lawyers and I waive any and all of my rights to any legal, or judicial proceeding in the United States, or anywhere else in the world, even if I am not aware that any rights are entitled or available to me.
Results of Surgery: I have not been given any promises or warranties regarding the outcome of/or results of my surgery. I have been given guidelines, outlining results and expectations. I understand that my results will vary and depend on many factors and variables and my results may or may not fall within the guidelines and expectations discussed.
Patients Initials: _________
Post Surgery Instructions and Follow up: I also understand that I may cause complications or have an unacceptable result if I do not follow my doctor’s instructions and postop diet after the surgery or fail to take the necessary medications, nutritional supplements or vitamin supplements. I also understand the importance of regular follow-up with my surgeon and notifying him if I am having any problems at any time after surgery. I realize that the ultimate success of this surgery is dependent not only on the procedure itself, but more importantly, to the changes that I make in my lifestyle and diet. To this end, I agree to follow my surgeon’s recommendations and instructions to include dietary and activity limitations, nutritional supplements, attending support groups and return/follow-up visits following surgery. I agree to abstain from tobacco and minimize the use of alcohol. Where applicable, I agree to use birth control to prevent and control pregnancies for at least 18-24 months post surgery. I also agree to participate in On-line chat/support groups, at least monthly as part of my overall weight loss program.
Health Maintenance Statement: I have been counseled on the importance of comprehensive preoperative screening and health maintenance. These tests may but not necessarily include but are not limited to chest x-ray, electrocardiogram, laboratory blood panel, mammogram, pap smear, bone densitometry, endoscopy, colonoscopy, abdominal ultrasound and pelvic ultrasound.
Financial hardship: I understand that if I choose to undergo this surgery outside of my insurance company (without their authorization or as a “self pay patient”). I may incur financial hardship and significant debt if I sustain a complication or have any problems following surgery. I realize also, that any complication that arises in the future will also be my responsibility and that my insurance will not cover these problems either (if the surgery is performed outside my medical insurance). I also realize that even if my insurance authorizes the procedure, they may only cover a portion of the total cost and I will be responsible for the balance. I hereby authorize and agree to pay any and all additional costs associated with any complications that arise out of my procedure. By signing this document, I agree to allow the doctor or his assignees to proceed to collect any amounts outstanding that may arise from any complications in any and all manners that they see fit, either in the United States or Mexico.
Having read this form in its entirety, my signature below acknowledges that I agree with and understand all of the statements and materials contained and set forth within this document. I am aware of the many risks of surgery, especially weight loss surgery, and fully understand them and accept these risks. I hereby also have read prior to my surgery and agree to, all of the terms and conditions set out on the legal page of Weightlossteam.com
PATIENTS NAME (Please Print): ______________
SIGNATURE OF PATIENT:______________
Witness’s Name (Please Print):____________ DATE:____________
SIGNATURE OF WITNESS: ______________
LAST DATE OF CHANGE: 08/12/16