FREE Bariatric Surgery Scholarship Application

Please answer the following questions to apply for the chance to receive a FREE weight loss surgery. Hurry! The application closes on Wednesday, April 15, 2026 at 11:59 pm EST.

Height & Weight

Have you had Bariatric Surgery in the past?

Which Bariatric Surgery have you had?

Do you have health insurance?

Upload Insurance Card Photo (Front)

Upload Insurance Card Photo (Back)

Date of Birth

Home Address

What is your preferred lab?

Preferred Pharmacy

What is your preferred language?

What is your TikTok Handle?

What is your Instagram Handle?

In 500 words or less, please tell us your experience with obesity, access to care, and any other information you would like to share.

Please provide up to 5 photos of yourself that include a clothed full body shot.

Medical Consent Checkbox

I understand that bariatric surgery is a medical procedure with risks and potential complications. If selected, I agree to undergo full medical evaluation, provide medical history records, and complete the informed consent process before surgery. This application does not guarantee medical approval for surgery.

Publicity Consent Checkbox

I grant BodyByBariatrics permission to use my name, written application, photographs, video content, and personal story in marketing, promotional, educational, and advocacy materials in any media format. I waive the right to inspect or approve final materials.

Photo Release Agrrement

I understand that photos and videos submitted with my application may be publicly shared as part of the Scholarship selection and promotional process.

Travel Costs

If selected, I understand that all travel, lodging, and personal expenses related to participating in the Scholarship and receiving surgical care are my responsibility.

Terms & Conditions Agreement

I have read and fully agree to the Terms & Conditions of the BodyByBariatrics Bariatric Surgery Access Scholarship. I certify that the information I have provided is true and complete.

Click hereto view the T&C

Presence at BodyByTransformation Retreat

I understand the winner MUST be present at the BodyByTransformation Retreat on Saturday, May 2, 2026.

Retreat ticket purchase required. Link with discount code will be sent upon submission of your scholarship application.

Planning on attending the BodyByTransformation Retreat

Submit Your Application

After you tap submit, we will follow-up with next steps! Good luck!