Forms

Below are some of the forms you will need throughout your journey with us. Please print and review required forms (marked with an asterisk *) before your first appointment.

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 preoperative evaluations, teaching, preoperative liquid protein diet guidelines and postoperative 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 postoperative behavioral therapy is run by Dawn O’Meally, LCSW-C.

• New Bariatric Patient Form *Mandatory*
• Informed Consent For Laparoscopic Gastric Bypass
• Informed Consent for Sleeve Gastrectomy
• Informed Consent for Biliopancreatic Diversion with Duodenal Switch
• Documentation of Supervised Non-Surgical Weight Loss Program for Insurance
• Bariatric Patient Pre-Appointment Checklist
• Requirements for Psychological Clearance