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Forms

Weight Loss Program and New Patient Forms

For new patients and participants of our weight loss program, please download and complete the following four (4) forms and bring them with to the start of your program. Also please have a look at the Recommended Pre-tests, and if you have the results of those tests, please bring them along as well.

Health History (168 KB PDF)

Notice of Privacy Practice HIPAA (129K PDF)

Informed Consent (179K)

Required Pre-Tests

Participation Requirements Summary (124K PDF)

Research Study Forms

For participants of research studies, please complete and fax the following form to us: (703) 807-0038
Research Screening Form (60 KB PDF download)
OR
Research Screening Form (40 KB view on-line)