Refer a Patient: Bariatric Surgery Center

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1. Gather required documents

A referral letter that includes:

• Diagnosis
• How long you've cared for the patient
• Patient's current body mass index
• Clinically significant comorbidities

Demographic page with current contact information

Copy of insurance card (front and back)

Authorization (if required) with CPT code 99205

Copies of clinical progress notes

Documentation of weight-loss attempts for three to six consecutive months during the bariatric workup. It must include:

• Duration of each program
• Initial weight and ending weight
• Weight-loss methods attempted (for example, diet and exercise; programs such as Jenny Craig, Weight Watchers or JumpstartMD; notes from consultations with nutritionists or dietitians)

2. Send everything to us

Visit the Bariatric Surgery section of the UCSF Department of Surgery website to complete our online referral form.

Have questions?

Call our new-patient coordinator:

(415) 353-2804