Success Stories

Share Your Story

Congratulations! You've made a life-changing decision and are now benefiting from this new, positive lifestyle. Please share your story with us, by filling out the form below. It's easy, it's fun, and you may make the difference in someone else's life. Currently, stories cannot be edited after they have been submitted. We are working on adding this functionality in the near future.

Your Privacy is Assured

Allergan will not sell, share, or otherwise distribute your personally identifiable information to third parties outside Allergan and its affiliated entities. To learn more, read our privacy policy.

*First Name:
*Your E-mail Address:
*Your Year of Birth:
*LAP-BAND^® System Surgery Date:

LAP-BAND^® System Surgery Performed in the United States:
	Yes No
*Height:	ft. in.
*Pre-op Weight:	lbs.
*Current Weight:	lbs
Your LAP-BAND^® Story
*Story Topic:
*Your Story:
Pre-op Picture:
Current Picture:
By submitting your LAP-BAND^® System story and/or photographs, and by checking the Release and Consent Box below you agree to release your name, likeness and personal story for posting on this website. You must be 18 years of age or older to particpate. You may remove your likeness and/or story from the lapband.com website at any time by contacting Allergan.
Terms of Usage:	I am a visitor of the website, www.lapband.com which is owned and operated by Allergan, Inc. I have agreed to contribute to the owner of the website my story about my experience with the LAP-BAND® System. In connection with assessing this website, I authorize Allergan, Inc. to display my story and/or photographs, if contributed, on lapband.com for the purpose of publicity and providing other people with an educational opportunity. The term "photograph" includes video and still photography, in digital or any other format, and any means of recording or reproducing images. I release Allergan, Inc., its employees, principals, agents, successors, assigns, beneficiary or heir (collectively referred to as "Allergan") as follows: • I release Allergan for the use of my name or story, and agree to permit Allergan to use my name or story for any purpose required or desired by Allergan in promotional publications, advertising, educational presentation, broadcast, cablecast or any purpose sponsored by Allergan. I further hereby release Allergan from any liability for the distribution of the story and/or photographs and also release all rights in and to any claim of copyright, trademark or other intellectual property or other rights, royalties, commission or any payment whatsoever in connection with the use of my photographs or story. • I understand that publication may be accomplished electronically via the Internet/World Wide Web and that after publication Allergan will be unable to prevent persons from gaining access to the Internet/World Wide Web, copying my likeness, photography, writing therefrom, and subsequently using, altering or republishing it without my consent. I understand and voluntarily accept the possibility of unconsented third party use, alteration or republication; and waive any claim for damages against Allergan arising from Allergan's publication of my likeness, photography and/or writing or from unconsented use, alteration, republication of my likeness, photography and/or writing by third parties accessing the Internet/World Wide Web. • I understand that Allergan may or may not use my submission at Allergan's sole discretion. • I understand that Allergan will not return my submissions and that my submissions will become the property of Allergan.
*Release and Consent:	By checking this box, I agree to the above terms of usage
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