Valley Weight Loss Forms

If able, please complete forms before your scheduled appointment to reduce check in time and give your provider an opportunity to review your medical health history.

New Weight Loss Patients

Patients who have scheduled with a provider for New Weight Loss are required to fill out forms below to continue with your appointment.

Once you have completed the forms please email them to contactus@valleyweightlossclinic.com or bring them with you on the day of your scheduled appointment. 

MedGem Metabolism Test

If you are scheduled for a MedGem Metabolism Test, please fill out the form below before you scheduled appointment. 

Please bring completed form to your scheduled appointment. 

Insurance Coverage Information

The form below can be used as a guide when calling your insurance company regarding weight loss medication coverage. 

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