Downloadable Forms

Downloadable FormsFor your convenience, we have placed all of our downloadable forms & booklets on this page. All documents are downloadable as a PDF file, and can be opened on both Windows & Apple machines. By completing forms in advance, it will not only save time during the check in process but will also allow you to give us the most complete and accurate information. Please take the time to complete each page so that we will have all of the information needed to best serve you.

Bariatric New Patient Packet  (PDF)

This set of forms is to be completed by each new bariatric patient and will be collected at the start of the seminar. Complete each section, if that sections does not apply, (i.e., you have not had any previous surgery) please indicate that by “none” or “not applicable” in the space provided. Please do not leave any blank sections. The information that you provide will help us determine not only if you qualify for surgery, but will also help us determine which procedure would best serve your needs.


Release of Information (PDF)

This form gives your physician’s office permission to send your records to us. You may print out the form & present it to your other physicians, releasing them to submit records on your behalf.


Post-Op Bariatric Lab Sheet (PDF)

This form contains a list of necessary lab work for those patients who have already had surgery. Lab work may be drawn by your PCP approximately 2 weeks prior to your scheduled follow-up appointment and faxed to our office for review. Or if you prefer, we can send you to our lab on the day of your appointment, Please remember that if you have your lab done by our office we will not be able to review your results with you during your follow-up appointment.


Patient Testimonial Forms (PDF)

If you are interested in sharing your success story, please complete the short questionnaire and return it along with pre & post-op photos to our office. If you have a particular story or personal accomplishment you would like to tell us about please include that information as well. We love to share in your victories & encourage others. If you have questions please contact [email protected] .


Bariatric Nutritional Guide (PDF)

We have recently updated our booklet Your Guide to Eating After Bariatric Surgery. This booklet is for ALL post-op bariatric patients, and includes dietary information & nutritional recommendations for Band, Sleeve, & Bypass patients.


Notice of Privacy Practices (PDF)

This Notice of Privacy Practices is being provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPAA). This Notice describes how we may use and disclose your protected health information to carry out treatment, payment or health care operation and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information in some cases.

 

Walk from ObesityBariatric Surgery Center of ExcellenceObesity Action CoalitionAmerican Society For Metabolic And Bariatric Surgery