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Healthy Weight Management & Bariatric Surgery

 

 


 


 


New Patient Forms


Before your first appointment, we ask you to complete a New Patient Health Analysis form. You can complete the form online or print out a PDF version that you can mail or fax to us.

If you are interested in our surgical weight loss options:

Please attend our in-person seminar or complete the online bariatric seminar 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 you are interested in the non-surgical weight loss options:

Please complete and submit both the New Patient Health Analysis form and the 3-Day Daily Food Diary form. We will then call you to schedule an appointment. 
 

Online Forms

Below are PDF versions if you would prefer to complete paper copies:

Please mail or fax the paper forms to us before your first appointment:

Healthy Weight Management and Bariatric Surgery
Lancaster General Health
2150 Harrisburg Pike, Suite 300
Lancaster, PA 17601
Fax: 717-544-3935

 
  BMI Calculator
 
  Height: ft. in.
  Weight: lbs.
Please enter a value for Weight
Weight must be a Number
Please enter a value for Feet
Feet must be a Number
Please enter a value for Inches
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Inches must be less than 12
  Your BMI:  
BMI Classification
<18.5 Underweight
18.5-24.99 Normal Weight
25-29.99 Overweight
30-34.99 Obesity (Class 1)
35-39.99 Obesity (Class 2)
>40 Morbid Obesity
 

 
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