Patient Forms

New Patients: Please complete the following seven forms labeled in red and either fax them or scan and email them to your first consultation with the doctor:

1) Patient Contact Information – click to download

2) Patient Questionnaire – click to download

3) Informed Consent – click to download

4) Group Confidentiality Agreement – click to download

5) Notice of Privacy Practices – click to download

Complete the following questionnaires if they apply to you and bring them with you:

6) Do you snore, are you tired or are you being treated for high blood pressure? – click to download

7) Do you have episodes of overeating? – click to download

Helpful Tools:

Loss of Visceral Fat with Weight Loss – click to download

Reasons I Want to Lose Weight – click to download

First Session Instructions-First Step – click to download

First Session Instructions-Better Weighs – click to download

Nutritional Information – click to download

Vegetable and Fruit Calories, sorted by calorie amount – click to download

Vegetable and Fruit Calories, sorted alphabetically – click to download

Better Weighs Meal Plan – click to download

MNP Recipes – click to download

MNP Health One Recipes – click to download *NEW*

Food Choices – click to download

Thom’s Potato Soup Chips – click to download

Torani Syrups, sugar-free – click to download

Measurements – click to download

Weight Loss Graph – click to download

BMI Chart–click to download

BMI for Asian and Asian American Adults- click 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

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

THE PLAN

We are closing our doors

We hope to have transitioned our patients to a healthy diet and to those on the liquid diet, to new providers.

Our weight loss strategy has always been "substituting low calorie foods for higher calorie foods".

Our patients have incorporated meal replacements as a part of their long-term diet plan.

With that in mind, we will continue to be able to provide meal replacements by the case, drop-shipped to your home. Each case contains 12 boxes, each box contains 15 packets. Each case needs to be a single-flavor. Please contact us to place an order.

OUR CLINIC NIGHT IS THURSDAY

Our address is 2516 Samaritan Drive, Suite B San Jose, CA 95124

Get Started Now! 408-370-1100 408-370-1102 fax

Email us at: info@mnpweightloss.com
Testimonials

“I heard about MNP from a trusted business associate who had been successful on the program… I joined in November, 2000 and reached my goal of losing 60 pounds and 6 sizes in March, 2001. This program taught me what I am capable of and revealed my habits to me so I could change my behavior.”
– TR, San Jose, California
Topics
- General (10)

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.