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Weight Loss Surgery
Cosmetic Plastic Surgery
Medical Weight Loss
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Referrals

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Home
About
Weight Loss Surgery
Cosmetic Plastic Surgery
Medical Weight Loss
Before & After Gallery
Patient Resources
Referrals

Home
About
Weight Loss Surgery
Cosmetic Plastic Surgery
Medical Weight Loss
Before & After Gallery
Patient Resources
Referrals

Menu

Home
About
Weight Loss Surgery
Cosmetic Plastic Surgery
Medical Weight Loss
Before & After Gallery
Patient Resources
Referrals

Submit Referral

Provider Name

Provider Phone

Fax Number

Contact Name

Patient First Name

Patient Last Name

Patient Phone

Patient Alternate Phone

Patient Email

Birth Date

Primary Insurance Company

Primary Insurance Group ID

Primary Insurance Member ID

Secondary Insurance Company

Secondary Insurance Group ID

Secondary Insurance Member ID

Patient Conditions

BMI 30-34 BMI 35-39 BMI 40+ Diabetes Type I Diabetes Type II High Blood Pressure High Cholesterol Osteoarthritis Spine Issues Thyroid Issues Heart Disease Kidney Disease Sleep Apnea Endocrine Issues

Refer a Patient to Dr. Frenzel’s BodEvolve Clinic

Thank you for your referral to Dr. Frenzel!

Choose the easiest option for you:

Call our Intake Line at (817) 342 0232 (selection #1)
FAX a patient face sheet with most recent office note to (866) 554-1950 Attn: Intake-Referrals
Complete our Online Form to the Left

Not currently accepting Medicare or Medicaid.

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469-529-5885

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817-342-0232

817-865-5490

Prolon may not be appropriate for all post operative bariatric surgery patients. If you are Dr. Frenzel’s patient, please contact our office for evaluation concerning this product. (817) 342-0232

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469-529-5885