Restaurant Card

This card is about the size of a normal credit card.  Print it out, print your name, and then take to your surgeon for signature.  Then have it laminated at your local Kinko's.


 Dear Owner/Manager

Patient Name
The above named patient has had gastric bypass surgery which has reduced his/her stomach capacity to less than 4 ounces.  We request that this patient be allowed to purchase a child's portion.

Surgeon Name

Thank You for your cooperation