Get Osubariatricsurgerycom Form

This guide provides step-by-step instructions for successfully completing the Osubariatricsurgerycom form online. By following these instructions, users can ensure that all necessary information is accurately filled out, facilitating a smooth application process.

Follow the steps to properly complete the Osubariatricsurgerycom form.

1. Press the ‘Get Form’ button to obtain the form and open it for editing.
2. Begin by entering your personal information in the designated fields, including your last name, first name, middle initial, and maiden name, if applicable. Fill in your address, city, state, and ZIP code.
3. Next, provide your social security number and date of birth. Indicate your age and select your gender from the available options.
4. Complete the demographic section by selecting your race and marital status.
5. Fill in your contact information, including home, work, and cell phone numbers, and indicate if you wish to receive communication via email.
6. List your employer and occupation, then provide information for your spouse, if applicable, including their name, date of birth, and employer.
7. Identify your primary healthcare provider and any referring physicians along with their contact information.
8. Read and complete the authorization for the release of information section, ensuring to provide your signature and the signature of a parent if you are a minor.
9. Provide insurance information, filling in details for both primary and secondary insurers, including policy numbers and any coverage specifics related to gastric bypass or lap-band procedures.
10. Indicate your preferred surgery options by circling the relevant choice from the list provided.
11. Answer medical history questions regarding conditions, medications, and any allergies you may have.
12. Document your diet history, including current weight, height, and weight loss attempts, with details about supervised programs and any previous diet medications.
13. Write a personal statement explaining your reasons for seeking weight loss surgery, and feel free to use additional paper if necessary.
14. Complete the feedback section at the end of the form to assist in improving services.
15. Once all information is filled out, ensure that all sections are complete, and save the form. You may choose to download, print, or share the form as needed.

Take the next step toward your health journey by completing the Osubariatricsurgerycom form online.