New Patient Forms

Find your care

Our bariatric surgeons use a range of treatments to help you reach weight loss goals and optimize your health. To learn more, call 310-825-7163.

Bariatric New Patient Forms

Please complete the documents and return them to our office via e-mail or fax prior to your consultation.

If you have any questions, please contact the office at 310-825-7163, option 2.

Patient filling out health forms at UCLA

New Patient Health History

Email Consent

Authorization for Release of Health Information

Lifestyle Questionnaire

Contact Us

To schedule a consultation with UCLA Bariatric Surgery in Los Angeles, California, call us at 310-825-7163 or fill out our online form.

For a physician referral, please call (800) UCLA-MD1 (825-2631).

*Weight loss results can vary depending on the individual. There is no guarantee of specific results. Read full disclaimer.