Forms
Below are some links and forms that our staff may direct you to along the way.
Financing Assistance:
- Care Credit has a special financing program for LAP-BAND patients!
- Advanced Patient Financing
- www.surgeryloans.com or 1-888-405-8740
Optional Orientation:
Medical and Insurance Forms:
Pre-operative Diet
Overview of the pre-operative diet.
Sample Letter of Medical Necessity
Sample letter for patients to provide to their attending doctor as a model for a letter of medical necessity.
Supervised Weight Loss Attempt Documentation
Suggested form for attending doctor to document supervised weight loss attempt for insurance purposes.
Spanish Orienation PowerPoint Show
Spanish Orientation
Insurance Verification Form
Please submit Insurance info through PATIENT PORTAL. If portal is unavailable, you can use this form to provide plan information for us to verify insurance benefits.