
Get Osu Wexner Medical Center Bariatric Surgery Program Application 2019-2025
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How to fill out the OSU Wexner Medical Center Bariatric Surgery Program Application online
Completing the OSU Wexner Medical Center Bariatric Surgery Program Application online is a crucial step for individuals seeking weight loss surgery. This guide provides clear, step-by-step instructions to assist you in filling out the form accurately and efficiently.
Follow the steps to complete your application online.
- Use the 'Get Form' button to access the application and open it for editing.
- Begin by entering the date and your personal information, including last name, first name, middle initial, address, city, state, zip code, home number, cell number, and email address. Ensure this information is accurate.
- Fill out the demographic information, including date of birth, gender, marital status, race, and current weight and height.
- Provide details about your primary care provider, including their name, address, city, state, and phone number.
- Enter your primary insurance information, such as the insurance company's name, address, policy holder's details, and coverage questions regarding gastric bypass or Lap-Band for morbid obesity.
- If applicable, complete the secondary insurance information using the same guidelines as step 5.
- Review the section for authorization of release of information, ensuring you understand your financial responsibilities. Then, sign the form.
- Provide a detailed medical history, answering the questions regarding tobacco usage, alcohol consumption, allergies, and medications.
- List any past surgeries in the designated area, including dates and types of surgeries performed.
- Indicate any illnesses or medical conditions you or your blood relatives have had by checking the appropriate boxes.
- Complete the insurance disclaimer form by contacting your insurance provider to verify benefits related to weight loss surgery. Document the required information.
- Upon completing all fields and sections, save your changes. You can then download, print, or share your application as needed. Ensure that a copy is retained for your records.
Begin your application online today to take the next step towards your weight loss journey.
To begin the process for the OSU Wexner Medical Center Bariatric Surgery Program Application, reach out to our team to schedule a consultation. During this initial meeting, we will review your medical history, discuss your weight loss goals, and explain our program. You will also receive guidance on the necessary evaluations and assessments needed to proceed efficiently through the application process.
Fill OSU Wexner Medical Center Bariatric Surgery Program Application
Please keep this as a reminder of what you need to do. We'd like to discuss the different types of bariatric surgery as well as what to expect before during and after any procedure. The study subjects will be recruited from The Ohio State University Wexner Medical Center.
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