PROGRAM POLICIES:

1. Intake Questionnaires

All patients:
Complete clinical and nutrition counseling intake questionnaires and submit via:

Online at:
https://myforms.hoag.org/weightmanagement
Fax:
949.642.7703
Mail To:
Mary & Dick Allen Diabetes Center
Attn: Bariatric and Medical Weight Loss Program
520 Superior, Ste. 150
Newport Beach, CA 92663

Bariatric Surgery Patients Only:
Complete above intake questionnaires

AND

Attend a live, virtual Bariatric Surgery Information Session:
Register at: https://www.hoag.org/community- education-classes/event-details/bariatric-surgery-patient-information-session/

IMPORTANT: The above requirements must be completed at least 24 hours PRIOR to your initial consult to avoid being rescheduled.

2. Patient compliance with structured program requirements has been shown in research studies to directly affect optimal weight loss outcomes. For that reason, we require patients comply with all program requirements and be active participants in the program.

Should we be unable to contact you for scheduling required consults or to obtain necessary information for timely progression and follow-up care, your eligibility to continue in the program may be reassessed by the clinical team.

3. The office must be given at least a 24-hour notice for appointment reschedules. Rescheduling or canceling less than 24 hours before your appointment will be considered a “No Show". Patients who chronically reschedule or have three “No Shows" signify a lack of dedication to the weight loss process and will be deemed inappropriate candidates.

By submitting this questionnaire, I confirm my interest in pursuing the Bariatric and Medical Weight Loss Program at Hoag Memorial Hospital Presbyterian and will comply with program policies and insurance regulations.

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Program Policy