Five Year Weight History

 
Most insurance companies will ask for records from the previous five years with documented weights showing morbid obesity. We can easily obtain these records from any physician you have seen in the previous five years including your primary care physician, internal medicine physician, gynecologist, pediatrician, or any other physician who has kept track of your weight.

Insurance companies will not accept a summary letter from your physician…they want to see the actual office visit records.

Please list all the physicians you have seen in the last five years.

Your Contact Information

Physician Information

The year you last seen this physician?

Physician Information

The year you last seen this physician?

Physician Information

The year you last seen this physician?

Physician Information

The year you last seen this physician?

Physician Information

The year you last seen this physician?

Physician Information

The year you last seen this physician?

Physician Information

The year you last seen this physician?

We will get started retrieving your medical records.

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