Patient Referral Form
As a physician, you can refer a patient to our services at the St.Vincent Bariatric Center of Excellence by printing, completing, and faxing the following form to our office.
Letter of Medical Necessity Template
The following is a letter template for physicians who are referring a patient for bariatric surgery. Please feel free to open the document and adjust the content to fit your patient and his or her conditions.
Letter of Medical Necessity Template
Supervised Weight Loss Forms
Many patients are required by their insurance carrier to complete a medically supervised weight loss program prior to surgery. Any weight that can be lost prior to surgery will aid in successful surgical outcomes.
For your convenience, we’ve included the 6 months supervised weight loss forms here:
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