Inova Bariatric Surgery Patient Forms

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.

• Bariatrics surgery medical history form
• Inova Medical Group patient registration form
• Authorization for claims payment and reviews
• Notice of privacy practices
• Acknowledgment of receipt of notice of privacy practices
• Release of medical information form
• ADA special needs assessment