
	Complete our free assessment to determine if you are a candidate for bariatric surgery.



	Use our free online BMI calculator to find out if your weight is a risk to your health.

Patient Forms & Documents

For your convenience, the following provides links to forms and documentation needed to progress through each stage of your weight loss program. In addition, you can download and/or print education handouts for your reference. As always, should you have any questions, please feel free to contact the Bridges Center at 1-800-248-5553.

Topic	Description
Free Weight Loss Seminars: 2011 Schedule Download PDF	All patients must attend one of the Bridges Center’s free informational seminars. A list of seminar dates, times and locations is available at our seminars page or on the printable schedule provided. To register by phone, call the Bridges Center at 1-800-248-5553. And, you can also view the weight loss seminar right from your computer at our webinar page.
Primary Care Physician Sample Referral Letter Download PDF	Some insurance plans require a referral or authorization in order for you to see a specialist. Please make the appropriate arrangements with your primary care physician. Refer to the sample letter provided. Remember to verify that the bariatric surgeon’s office has received your physician’s referral prior to arriving to your appointment.
Weight Loss Seminar Packet Download PDF	All seminar attendees receive a seminar packet upon arrival at the event. A PDF sample is provided here.
Medically-supervised Diet Requirements Download PDF	Some insurance companies require that you provide documentation outlining your diet history, including monthly visits within the last two years and a physician’s signature on each monthly notation. If your insurance company requires diet history information, please print and complete the Bridges Center diet requirements form.
Insurance Verification Download PDF	A completed insurance verification form must be submitted to the Bridges Center upon the completion of any weight loss seminar. If you attend a weight loss seminar at one of our Valley locations, this form will be provided at the event. If you view our online webinar, please download, print and complete the form provided here.
Health History	Before attending your one-on-one consultation with your surgeon, please provide the required health history information. Your health history information must be received by the surgeon’s office in time for your consultation. Please submit your health history online: For surgeries at St. Luke’s Medical Center, click here. For surgeries at Tempe St. Luke’s Hospital, click here. If you prefer submitting information in writing, please download the Exemplo form, fill in your information and bring the completed form with you to your one-on-one consultation with your surgeon.

Additional Helpful Resources
The following are additional informational and educational materials, designed to help you throughout your weight loss efforts.
Types of Bariatric Surgery Download PDF	This handout provides a summary of the types of bariatric surgery offered at the Bridges Center. In addition, this handout briefly describes each surgical procedure, outlines how each procedure affects the digestive process, provides an estimated length of stay in the hospital and summarizes statistical health benefits of bariatric surgery.
Food Intake Journal Page Download PDF	Keeping a record of your food intake is an effective way to help you reduce meal portions and fat intake. This may also be helpful in providing your primary care physician and Bridges Center surgeon with additional information about diet.
Exercise/Physical Activity Journal Page Download PDF	Daily physical activity or exercise is essential to losing weight. Engage in at least 30 minutes of physical activity each day and record your results in a journal. In addition to tracking your exercise regime, you’ll enjoy the satisfaction of a job well done!
Body Mass Index (BMI) Chart Download PDF	Need to take the Body Mass Index (BMI) chart with you? Here, we’ve provided a printable chart for your reference.
General Nutritional Guidelines: Pre- and Post-Surgery Download PDF	Whether you are jump starting your weight loss program prior to surgery, or adjusting your diet following surgery, this handout provides an at-a-glance view of general nutritional guidelines. Print this out and attached it to your fridge for a helpful reminder as you prepare meals at home.


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