Patient Information & Forms

Bariatrics Patient Survey—Weight-loss surgery can change your health, and your life.  If you are interested in more information about surgery and learning if you qualify for the procedure, please fill out the questionnaire attached and submit it based on the instructions.

Bariatrics Patient Packet—Once you are considered a potential candidate for surgery, you will be asked to fill out this Bariatrics Patient Packet.  Please download the form and complete the form prior to your first visit with West Florida Weight Loss.

Bariatrics Fee—Information and form regarding the bariatric program fee for insurance patients.

Gastric Bypass Instructions / Consent Form—Prior to having Gastric Bypass Surgery you will be asked to read the attached consent form and sign the document as to your understanding of the procedure that is being performed.  This form may be download here.  This form includes information about the operation, Expected Outcomes & Patient Commitments, Diet, Risk of Operation, Other Undesirable Outcomes, Fees, and a Summary.

Lap-Band Instructions / Consent Form—Prior to having Lap-Band Surgery you will be asked to read the attached consent form and sign the document as to your understanding of the procedure that is being performed.  This form may be download here.  This form includes information about the operation, Expected Outcomes & Patient Commitments, Diet, Risk of Operation, Other Undesirable Outcomes, Fees, and a Summary.

Communication Release Form—A form authorizing Surgical Associates of West Florida to contact you. Form allows you to specify preferred method of communication, and other parties to whom your health information may be released.

Laparoscopic Sleeve Instructions / Consent Form — Prior to having the Laparoscopic Sleeve procedure you will be asked to read the attached consent form and sign the document as to your understanding of the procedure that is being performed.  This form may be download here.  This form includes information about the operation, Expected Outcomes & Patient Commitments, Diet, Risk of Operation, Other Undesirable Outcomes, Fees, and a Summary.

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