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.
__________________________________________________________ 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