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New Weight Loss Patient

Access new patient information and paperwork

Your First Weight Loss Visit

Filling out the New Patient forms before you get to the office can save you time on your first visit. Please fill out the required forms found below. You can either download the forms to print, fill out, and turn in to the office assistant upon arriving at the office, or you can fill out the online form and submit it. If you are unable to complete the paper work prior to your visit, please arrive approximately 15 minutes early, so that sufficient time is available to fill out the necessary paperwork.

If you have an insurance provider, bring your card to your first appointment. If you have digital or film x-rays that were taken within the past 30 days, please bring them with you. Upon examination further x-rays may be required.

Print Form to Fill Out and Bring With You to the Office:

Download Form

OR
Fill Out The Form and Submit Online:

  • Date Format: MM slash DD slash YYYY

    1 = not committed, 10 = highly committed
  • Weight loss can be complex. If you have failed in the past, it could be because you have some of the following:

























  • Height