New Patient Forms
If interested in surgical weight loss options:
Please complete the online bariatric surgical seminar or attend one of our in-person seminars before completing the New Patient Health Analysis form. After you complete the seminar and submit the form, we will call you to schedule an appointment with one of our bariatric surgeons.
If interested in the non-surgical weight loss options:
Please complete and return both the New Patient Health Analysis form and the 3-Day Daily Food Diary form to our practice. We will then call you to schedule an appointment.
New Patient Health Analysis form
3-Day Daily Food Diary form (only required for non-surgical weight loss)
The forms are in PDF format. Please print and complete them per the instructions above.
Please mail or fax the forms to us before your first appointment:
Healthy Weight Management and Bariatric Surgery
Lancaster General Health
2150 Harrisburg Pike, Suite 300
Lancaster, PA 17604
Fax: 717- 544-3935