Iowa Weight Loss Specialists
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Adopt a Family - Giving Tree

This year Iowa Weight Loss Specialists would like to adopt a family in need for Christmas.  We have decided that the family we would like to choose this year will be a patient and their family.  If you and your family are struggling this holiday season, please fill out the application below.  This is will remain anonymous to our general staff and public.  There will be 1-2 Iowa Weight Loss management staff members that will see application information.  
 

  • Deadline for patients to submit application - Monday, November 22nd
  • Patient that is chosen will be notified on Wednesday, November 24th.
  • Gifts will be wrapped by staff and must be picked up from Iowa Weight Loss Specialists at our West Des Moines office between December 15th-20th. ( A staff member will reach out to arrange pick up.)

 

This information will be used by Iowa Weight Loss management staff to determine which patient and family we will choose. It will also be used to contact the patient to arrange gift pick up.

* Indicates a required field

If a required field does not apply to you, please enter N/A.

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*  limit: 700 characters.
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Patient's Gender:
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*  limit: 500 characters.
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Spouse or Significant Other's Gender:
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*  limit: 500 characters.
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Child #1 - Gender:
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*  limit: 500 characters.
 limit: 500 characters.

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Child #2 - Gender:
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*  limit: 500 characters.
*  limit: 500 characters.
 limit: 500 characters.

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Child #3 - Gender:
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*  limit: 500 characters.
*  limit: 500 characters.
 limit: 500 characters.

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Child #4 - Gender:
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*  limit: 500 characters.
*  limit: 500 characters.
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