Patient Forms

New Patient Forms

New Patients, please print and complete the forms listed below and bring them with you to your first appointment.

• Full Patient Update
• Patient Health History Sheet
• Patient Weight Loss and Medical History Questionnaire
• Activity Restrictions

During Your Surgery Journey

These are forms you may need along your surgery journey.

• Medically Supervised Diet Sheet
• What Do I Want to Know?
• Request for Medical Clearance from PCP

 Other Information

• Consultation Prep
• Financial Information with Insurance Coverage
• BLIS Information

 Patient Notices

• Notice of Privacy
• Affordable Care Act: Section 1557 – Nondiscrimination & Interpreter Services Notices