Refer a Patient: Bariatric Surgery Center

Contact Us

Step 1: Gather required documents

You will need:

1. A referral letter that includes:
• Diagnosis
• How long you've cared for the patient
• Patient's current body mass index
• Clinically significant comorbidities
2. Demographic page with current contact information
3. Copy of insurance card (front and back)
4. Authorization (if required) with CPT code 99205
5. Copies of clinical progress notes
6. 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)

Step 2: Send everything to us

Fax the documents to the number listed above.

Have questions? Please call our new-patient coordinator at the number above.