Patient Nomination — Endura Weight Loss Solutions

Step 1 of 4

Your details

As the nominating physician

Doctor's full name

Please enter your name

Your mobile number

+91

Please enter a valid 10-digit mobile number

Your email address

Please enter a valid email address

Hospital / Clinic

Please enter your hospital or clinic

City

Please enter your city

Step 2 of 4

Patient details

Name and mobile number

Patient's full name

Please enter the patient's name

Patient's mobile number

+91

Please enter a valid 10-digit mobile number

Step 3 of 4

Procedure details

Which procedure was performed and when?

Procedure type

Procedure date

Please select the procedure date

Step 4 of 4

Confirm & submit

Review all details before submitting — tap Edit to make changes

Nominating doctor Edit

Name

—

Mobile

—

Hospital

—

City

—

Patient Edit

Name

—

Mobile

—

Procedure Edit

Type

—

Date

—

What happens next: The Good Weight will contact the patient within 24 hours to begin the after care program. A WhatsApp message will be sent to the patient and emails will go to Boston Scientific and The Good Weight team.

Nomination submitted!

The Good Weight will contact the patient within 24 hours to begin the program.

Emails sent automatically

A nomination confirmation has been sent to your email, to Boston Scientific, and to The Good Weight team.

One action required from you

Send a WhatsApp to the patient to let them know they are enrolled. The message is pre-written — just tap Send.

The Good Weight

Call for any support +91-9363016300