Birmingham Bariatric Care

New Patient Intake Form

Please complete this form before your appointment. Your information is confidential and protected under HIPAA guidelines.

Patient Information
Insurance Information
Reason for Visit
Medical History

Check all that apply:

Current Medications & Supplements
Lifestyle Information
Consent and Acknowledgment
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New Patients

Everything you need to know before your first visit. Learn what to expect, what to bring, and how our personalized weight-loss programs begin.

Forms & Downloads

Access important forms in advance to save time at your appointment. Complete them online or download and bring them with you

Policies

Transparency matters. Review our policies on appointments, cancellations, and telehealth to help your experience run smoothly.

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