Weight Loss Clinic Patient Forms

Please complete the following five forms and bring them with you to your first consultation with the doctor:

1) Patient Contact Information – click to download

2) Patient Questionnaireclick to download

3) Informed Consentclick to download

4) Group Confidentiality Agreementclick to download

5) Notice of Privacy Practicesclick to download

These forms will help you keep track of your progress, choose the one that works best for you:

Calorie and Exercise Log  – click to download

Calorie and Exercise Record  –  click to download

Weekly Log Sheet –  click to download

Weekly Record Sheet –  click to download

Measurements – click to download

Weight Loss Graph – click to download

Helpful Tools:

First Session Instructions-First Step  –  click to download

First Session Instructions-Better Weighsclick to download

MNP Recipes – click to download

Reasons I Want to Lose Weight – click to download

Taxpayer’s Guide to IRS Policy to Deduct Weight Control Treatment – click to download

Food Choices – click to download

Nutritional Information – click to download

Vegetable and Fruit Calories – click to download

We are a physician supervised weight loss program and medical diet program serving clients serious about losing weight and keeping it off in Northern California and the south San Francisco Bay Area, including San Jose, Los Gatos, Saratoga, Campbell, Cupertino, Santa Clara, Sunnyvale, Morgan Hill, Gilroy, Hollister, Mountain View, Los Altos, Palo Alto, Milpitas, Fremont, and Santa Cruz.