Forms for Patients

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Weight-loss surgery is complex, and is only one step in a long process. We make every effort to expedite this process for you. We ask that you fill out the forms on this site in as much detail as you can, so we can help you achieve your health goals.

In this section, you’ll find the forms needed for your Initial Visits. Also, this is where you’ll find information on Diet and, under Miscellaneous Forms, our Patient Handbook on Exercise. These are important components in achieving and sustaining successful weight-loss after surgery.

Your health goals are important to us. We look forward to working with you to achieve them.

Initial Visit Removed per NW request

Registration Form

Initial Evaluation Form

Insurance Coverage Inquiry

GERD-HRQL Scale (Gastroesophageal Reflux Disease)

Diet

Lap-Band Patients Diet

RNY Gastric Bypass Patients Diet

Lap RNY Gastric Bypass Patients Diet

Miscellaneous Forms

Patient Handbook-EXERCISE