Forms

After scheduling your FREE consultation, please read the HIPAA statement and fill out the electronic health history form. You will not be able to fill out the history form until you have scheduled your appointment, so please call (907) 561-3488 now!

READ:
HIPAA (Health Insurance Portability and Accountability Act)

FILL OUT:
Electronic Version:
Electronic Medical History Form
*You will be asked for a Patient ID when filling out the form, which you should've received when you made your appointment. Please enter it IN ALL CAPS. If you do not have or do not remember your Patient ID, please call (907) 561-3488.

Paper Version:
Medical History Form
Patient Registration Form

Insurance Information

Frequently Asked Questions

How much do the programs cost?
The programs' costs vary depending on upon which program is selected. Fees vary based on insurance coverage and diagnostic tests needed. Meal replacements and medications are additional.

Will my insurance cover the program?
Insurance coverage varies. Some companies provide close to 100% of coverage whereas others completely exclude obesity treatment. It is best to review your policy holder's manual.

Which insurance plans are currently providing coverage?
This question is a moving target. It really depends on where you work and what benefit components are included in the insurance coverage purchased. As of July 1, 2010, the following insurance companies have shown some degree of coverage: ASEA - Local 52, IBEW, NEA, Premera (select groups), Aetna, Principal, CIGNA, Federal Blue Cross, Meritain and Wells Fargo. It is important to note that benefit quotes are NOT a guarantee of coverage!

Will you file my insurance for me?
If it has been confirmed that your insurance provides coverage for our services, we will file your insurance claim. You are responsible for any deductibles, copays and amounts not covered by your policy.

I only need to lose 20 lbs. Can I still be on one of your programs?
You must have a BMI (Body Mass Index) of 27 or higher to be an appropriate candidate for one of our programs. To calculate your BMI, go to the Resources page of our website where you can find a BMI chart. Please call our office for more detatils.

I am a diabetic and have high blood pressure. Can I be on one of your programs?
We often work with Type II diabetics and patients who are hypertensive. Please call our office for more details.

How fast will I lose my excess weight?
Rate of weight loss is dependent upon your metabolic rate, caloric intake and energy output. How fast you will lose weight can be impacted by which weight loss program you are on (i.e. OPTIFAST© vs. Calorie Counting). Your close adherence to the individualized program you develop with the provider is a key factor.

Do you have a maintenance program?
All our programs are focused on long term weight loss management. Close monitoring and ongoing guidance and support prepare each patient for a lifetime of weight maintenance.