The following PDF forms will need to be completed for your first visit to our office. You are welcome to print them from our website and bring them with you to your scheduled appointment.

We also invite anyone who visits this page—whether you’re one of our patients or not—to download Baritastic, a free app that allows you to engage with our program while also tracking food and other bariatric program activities.

New patient forms

Bariatric health packet with patient registration form
(For bariatric surgery patients only)

Patient signature on file form

Patient demographic data sheet

Instructions for authorization to disclose protected health information (PHI)

Authorization to disclose protected health information (PHI)

Patient financial policy form

Main Line Health notice of privacy practices

Acknowledgement of receipt – MLH notice of privacy practices

Non-discrimination and availability of services notice

Established patients

Vitamin and mineral supplementation post-opfor bariatric surgery patients only

To request a copy of your medical records:

For your convenience, we have also included a link to a commonly requested form: