Completed forms
Bring any forms the office has asked you to complete before your appointment.
Patient Forms
Helpful forms and preparation steps for new patients.
These resources help Rochester Medical Weight Loss understand your medical history, weight history, habits, goals, and readiness before beginning a physician-guided plan.
New Patient Checklist
If you are accepted as a patient, our team may ask you to complete the forms below before your appointment. If you have questions about what is required, please call the office.
This printable form asks about medical history, medications, weight history, lifestyle, eating habits, and other information that may help guide care.
Open the medical history form → QThis questionnaire helps identify patterns, habits, barriers, and support needs before starting a weight loss plan.
Complete the questionnaire →Before You Begin
Not every person seeking medical weight reduction is automatically a fit for every program offered by Rochester Medical Weight Loss. Before being accepted as a patient, you may be asked to participate in a short intake interview to help determine whether our programs are appropriate for your needs.
If accepted, you may be asked to complete forms before your first visit so your care team can better understand your health history and goals.
What to Bring
Bring any forms the office has asked you to complete before your appointment.
Bring a current list of medications, over-the-counter products, vitamins, and supplements.
Write down any questions about programs, expectations, cost, nutrition support, or medications.
Be ready to share past weight loss attempts, health conditions, routines, barriers, and goals.
Financial Note
Rochester Medical Weight Loss is a private pay practice and does not bill insurance directly for program fees. Patients accepted to the practice are responsible for payment for services received.
Questions?
Our team can help you understand which forms apply to your visit and what to bring with you.
61C Monroe Ave.
Pittsford, NY 14534
Ready to Take the Next Step?
A Wellness Coordinator can help you understand scheduling, next steps, and what information may be helpful before your first visit.