Downloadable Forms for Weight Loss Surgery
| Form name | Description |
| Notice of Privacy Practices | Southwest Bariatric Surgeons, PLLC Notice of Privacy Practices |
| Diet History Grid | Grid your primary care physician can complete to help meet your insurance company's physician-supervised diet requirements |
| Medical Release Request | Medical records release form |
Would you like to schedule a New Patient appointment?
Please click here to attend a live or online weight loss surgery seminar.
You'll receive New Patient forms at the live seminar or be able to download them on the online seminar page. (On the online seminar page, click the "Becoming a Patient" link.)
Did you attend the seminar online? And do you already have your New Patient appointment?
Click here for special forms we'd like you to complete and bring to your first appointment. These forms are included in the folder that patients receive at the live seminar. Your Patient Advocate will have provided you with a login and password to access these forms. (You don't need these forms until AFTER you have sent us the New Patient forms and scheduled an appointment.)
Are you working on meeting your insurance company's diet history requirements?
Click here to download a diet history grid to take to your primary care or other physician. Your physician can use this form to document your physician-supervised diet. Using this form is certainly not required, but this form is an easy way to track the information most insurance companies want to see.
