Below are some of the forms you will need throughout your journey with us, whether you are interested in weight loss procedures or gastroenterological surgery. Forms are grouped by Bariatric Surgery, Reflux/Hiatal Hernia surgery, and General Surgery procedures. Please print and review required forms (marked with an asterisk *) before your first appointment.
You can look through the informed consent documents for different surgical procedures outlining all known risks of surgery. Most of these complications have never been experienced by our patients, but that information is useful in making your decision.
Also below are patients' contracts and consent agreements describing the importance of vitamin supplementation, smoking cessation prior to surgery, and understanding of pregnancy and fertility issues associated with bariatric surgery.
For your convenience, all forms related to dietician pre-operative evaluations, teaching, pre-operative liquid protein diet guidelines and post-operative support can be found under the "Forms" section at The GI & Bariatric Nutrition Center on www.Nutrition5.com by Nancy Lum, RD, LDN, our bariatric surgical dietician.
Information regarding pre-operative psychological evaluation for bariatric surgery and post-operative behavioral therapy can be found at www.bariatricpsychservices.com run by Dawn O'Meally, LCSW-C.
- New Bariatric Patient Form *Mandatory*
- Informed Consent For Laparoscopic Gastric Bypass
- Informed Consent for Sleeve Gastrectomy
- Documentation of Supervised Non-Surgical Weight Loss Program for Insurance
- Bariatric Patient Pre-Appointment Checklist
- Requirements for Psychological Clearance
- Patients Contract: Vitamins and Protein Supplements
- Patients Contract: Smoking Cessation
- Patients Contract: Understanding Pregnancy, Fertility, and Weight Loss Surgery