If you are a new Bariatric Patient, please click on the links below to complete the necessary forms and assessments. Your first visit can only be scheduled after we analyze the completed paperwork.
First, we need information on your history and experiences. We kindly request that you complete these forms in a secure and private location. We would also ask that you answer these questions as openly and honestly as possible, without hesitation. If you require assistance with completing the forms, help from others is fine, but no coaching should occur during that assistance.
HIPAA Notices of Policies and Practices are included, and you can be assured that your privacy regarding this information is of utmost importance to us. In compliance with HIPAA, the only individuals who will have access to this information are Dr. Douglas Cox, Ph.D., your insurance provider (who requested your visit), and the referring physician.
If at any time you are unsure as to how to complete the forms, please call Melody at 865-382-7256, and she will talk you through it.
We appreciate your diligence in completing these forms and assessments as soon as possible. Please let us know if you encounter any issues.
As soon as you submit any information, it is immediately stored in a secure database. Caution – If you leave the page before submitting the form, your data will be lost, because we can not keep your information in the memory of this website.
Please fill out the following four forms: