We’ve conveniently uploaded all of the forms that we’ll need from you right here. If any questions arise as you do the paperwork, please don’t hesitate to call us! We’re happy to help: 702-463-3300
Click on the form below to download
- Insurance Verification
- New Patient Packet – Please fill out to help us obtain insurance benefits.
- Psychological Evaluation – Please fill out the psychological evaluation form.
- Lab Order for Insurance Patients
- Lab Order for Cash Patients
- Release of Medical Information – Use this form for Authorization for Release of Medical Information.
- Consent for Laparoscopic Gastric Sleeve Resection – Use this form for Informed Consent for Gastric Sleeve Resection.
- Consent for Roux-en-Y Gastric Bypass Surgery – Use this form for Informed Consent for Roux-en-Y Gastric Bypass.
- Consent for Gastric Band – Use this form for Informed Consent for Adjustable Gastric Band Placement.
- Consent for Gastric Band Adjustment – Use this form for Informed Consent for Gastric Band Adjustment.
- Consent for Operations, Procedures and Other Treatments – Use this form for Informed Consent to Operations, Procedures and Other Treatments.
- Consent for Stomach Intestinal Pylorus Sparing Surgery (SIPS) – Use this form for Stomach Intestinal Pylorus Sparing Surgery (SIPS).
- Scheduling Deposit & Cancellation Policy – Use this form to Understand the Scheduling Deposit and Cancellation Policy.
- Surgical Clearance Form
- Welcome Back Packet – For Former Patients
- Full New Patient Binder – Essential Information For New Patients
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