Request an Appointment with
Dr. Mohiuddin

Complete This Short Form

What type of appointment do you want?

Weight Loss Surgery

General Surgery

What type of general surgery are you interested in?

Height & Weight

What is your preferred payment option?

Self-Pay / Financing

Insurance

Insurance Information

Insurance Card Photo (Front)

Insurance Card Photo (Back)

What is your preferred language?

Contact Information

By checking this box, I consent to receive text messages related to appointment updates from Capital Surgeons Group, PLLC. You can reply “STOP” at any time to opt-out. Message and data rates may apply. Message frequency may vary, text HELP to (512.302.1210) for assistance. For more information, please refer to our Privacy Policy and Terms and Conditions on our website.

Last Step: Click "Submit" Below

You will receive a text and email in the next few minutes to confirm we received your submission.