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When patients elect to have weight loss surgery, their insurance companies require a great deal of information in order to pre-qualify someone as an appropriate candidate.

In order to provide your insurance company a complete “Letter of Medical Necessity,” we need you to complete our Medical and Diet History Questionnaire.

Please download and complete the attached form and bring it to your first visit with the surgeon. This will expedite your experience in our office and with your insurance company.

Questionairre Questionairre
Medical and Diet History Form