New Bariatric Patient Documents

All new patients are required to complete our new patient questionnaire and forms.  You may complete these via our, mobile-friendly, form by clicking HERE.  The forms take 30-40 minutes to complete.  Once completed it will automatically email our office and you a copy for your records.  
 

WE CANNOT SEE YOU WITHOUT THESE DOCUMENTS.  Failure to complete the forms prior to your initial consultation WILL result in your needing to be rescheduled.  All appointments canceled with less than 36 business hours notice are subject to a $45 missed appointment fee.  

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GIBNC Bariatric Program Services

Services included in our Bariatric Nutrition Education Program. 

Doctor or Dietitian Supervised Weight-Loss Documentation

Most insurance companies require anywhere from 3-6 consecutive months of supervised weight loss documentation.  To determine the requirements of your insurer please contact your surgical coordinator at your surgeon's office.  

 

Why use GIBNC? Our documentation includes 30-40 minutes of support group style education that feeds off our long-term education.  This format offers ongoing support from other patients as well as the dietitian teaching.  We emphasize preparing for what you will be doing long term and eating normally.  We will help you with creating new habits needed for long term success.  

 


 

Post-Op Reminders

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Other Documents

All faxes to our office must be accompanied by a fax cover sheet.  Faxes without coversheets are destroyed.  PLEASE PRINT. 

Follow-Up and Non-Bariatric Questionnaire

If you have scheduled a follow-up and have not seen us within the prior 12 months, please complete this questionnaire and bring completed to your consultation.  You may also fax to 443-490-5060 or email to us using our contact form on this website NO LESS than 48 business hours prior to your appointment.

 

Non-Bariatric New Patients, please complete this questionnaire and bring completed to your consultation.  You may also fax to 443-490-5060 or email to us using our contact form on this website NO LESS than 48 business hours prior to your appointment.   

 

If you are unable to complete the document prior to your consultation you may be required to reschedule your appointment.  There is a $5.00 fee for printing this document for you.   

$5.00, if you are unable to print yourself

Follow-Up and Non-Bariatric Patient Forms

This packet includes documents such as our financial policy, HIPAA , agreement regarding our materials, etc. Please bring signed forms to your consultation.  You may also fax them to 443-490-5060 or email using our contact form on this website NO LESS than 48 business hours prior to your consultation.  

GIBNC Services

Services offered by GIBNC. 

Meet our Dietitians

Directions to our Offices and Inclement Weather Policy

Yearly Lab Recommendations

These are the labs that we recommend for a full vitamin panel to detect any vitamin/mineral deficiencies.  As we are not medical doctors but registered dietitians, you must take this slip to your MD to have them write the order up to take to your laboratory.  

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