American Family Children's Hospital

Request More Information From the Surgical Weight Management Team

Thank you for your interest in contacting UW Health's Surgical Weight Management Program in Madison, Wisconsin.
Please complete the form below and a member of our staff will contact you.
Please note: All fields except Body Mass Index are required.
Please do not submit urgent questions about your medical care through this website. If you are experiencing a life- or limb-threatening emergency, call 911. If your need is urgent, call your clinic for assistance.

Name (First and Last)
E-mail Address
Phone Number (Include Area Code)
Home Address
ZIP Code
Insurance Provider
Best time to reach you between 9am-4pm
Your Height and Weight
Body Mass IndexBMI Chart
Your Date of Birth
Additional comments/questions