Vital Weight Loss MD
Vital Weight Loss MD
  • Weight Loss
  • Medications
  • BCA
  • Adolescent Obesity
  • Body Sculpting
  • Intermittent Fasting
  • Peptides
  • Complications
  • New Patient Forms
  • More
    • Weight Loss
    • Medications
    • BCA
    • Adolescent Obesity
    • Body Sculpting
    • Intermittent Fasting
    • Peptides
    • Complications
    • New Patient Forms
  • Weight Loss
  • Medications
  • BCA
  • Adolescent Obesity
  • Body Sculpting
  • Intermittent Fasting
  • Peptides
  • Complications
  • New Patient Forms

New Patient Forms

Please fill out the appropriate intake form - either Private Insurance/Cash or Medicare - and the Weight Questionnaire by clicking on the appropriate links below before your upcoming appointment. Once completed, press SUBMIT at the end of each form. BOTH forms must be submitted and signed to keep your appointment.

Private Insurance/Cash Intake Form

Please take a photo of your ID and the front and back of your insurance card, if any. More than one signature will be required on the Intake Form.

Click Here

Medicare Intake Form

Please take a photo of your ID and the front and back of your insurance card, if any. More than one signature will be required on the Intake Form.

Click Here

Weight Questionnaire

Click Here

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6 Free Body Sculpting Sessions

Mention this ad when you enroll for medical weight loss management and receive 6 free body sculpting sessions ($3,000 value). San Francisco and  Walnut Creek clinics only. 

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