The following PDF forms will need to be completed for your first visit to our office. You are welcome to print them from our website and bring them with you to your scheduled appointment.
We also invite anyone who visits this page—whether you’re one of our patients or not—to download Baritastic, a free app that allows you to engage with our program while also tracking food and other bariatric program activities.
Complete your forms using MyChart. Main Line Health MyChart makes it easy for you to schedule appointments, request prescription refills, pay your bills, send messages to your doctor’s office when you have non-urgent medical needs, and more—from any device.
New patient forms
Medical weight management health packet
Bariatric surgery health packet
Patient signature on file form
Patient demographic data sheet
Instructions for authorization to disclose protected health information (PHI)
Authorization to disclose protected health information (PHI)
Main Line Health notice of privacy practices
Acknowledgement of receipt – MLH notice of privacy practices
Non-discrimination and availability of services notice
Care for the post-op bariatric surgery patient
Vitamin and mineral requirement guide for the post-op bariatric surgery patient
To request a copy of your medical records:
For your convenience, we have also included a link to a commonly requested form: