Patient Forms

Your Support Person MUST be present at the consult and consent appointments. Failure to do so will result in rescheduling your appointment

Your appointment will be rescheduled if you do not have your photo ID and insurance card at time of appointment.

The following Bariatric patient forms are provided for your convenience. Please fill these out and bring them with you to your appointment. If you have any questions regarding the information requested, call us at 303-452-0059 and we can assist you.

If you do not have Adobe Reader to view the following PDF forms you can download a free plug-in by clicking on the Adobe Reader button.

Patient Forms to bring to your first visit

*Your appointment will be rescheduled if you do not have a photo ID and insurance card at time of appointment

	Weight Loss Surgery Health Questionaire (Required)
	HIPAA Acknowledgment & HIPAA Authorization (Required)
	HIPAA Privacy Notice (For your records)
	Bariatric Surgery Reveiw (Required)
	Release of Information (As Needed)

These forms contain important information for you to read prior to your appointment. You may to choose to print them or save to your computer.

	Patient Flow Worksheet
	Financial Information
	Expediting Your Surgery
	Guiding Principles For Significant Others

All the Patient Forms are Adobe PDF files and require an Adobe Acrobat Reader If you do not have a copy, you can obtain a free copy of the Reader from the Adobe site. Click on the Adobe logo below go download the Adobe Reader.