If you are a new patient to the Inova Bariatric Surgery practice, please complete the forms below and bring them with you to your appointment.
Please arrive 15-20 minutes before your appointment to complete any other needed paperwork. Also remember to bring your insurance card and photo ID to each visit, as well as a list of your medications (prescription and over-the-counter) and a referral if required by your insurance.
- Initial evaluation for bariatric surgery (includes medical history)
- Inova Medical Group patient registration form
- Authorization for claims payment and reviews
- Notice of privacy practices: English | Additional languages
- Acknowledgment of receipt of notice of privacy practices
- Release of medical information form
- ADA special needs assessment
