We're Accepting New Clients
Services
HPC Team
Bariatrics & Health
Health At Every Size
What Makes Us Different?
Bariatric Services
Non-Surgical Support for Health
Bariatric Support Group-New Dates!
GLP-1/Health-Weight Management Support Group
Contact & Scheduling-Counseling
Contact & Scheduling- Pre-Surgical Eval
Insurance and Payment
We are a small business-which means we provide individual attention from the first call, to scheduling, to billing, and more. When you need to get a document to your doctor, we personally handle it. When you need to expedite an appointment, we shift our schedules, when we can, to make it happen. We ask that you have patience when we are returning your calls or emails. We respond to every call and email. We try to return calls same day, however we ask for 24-48 hours. If it is a weekend, we will not get back to you until the following week. Thank you for your support of our team as we work to provide specialized care and personalized communication.
Please provide all of the information below to begin the scheduling process for your pre-surgical evaluation
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Indicates required field
Name
*
First
Last
Email
*
Phone Number
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State you reside in
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Health Insurance Carrier
*
Member ID Number
*
Group Number
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Do you have any secondary insurance plan? (if so, you must indicate here)
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Yes, I have a secondary insurance plan
No, I do not have a secondary insurance plan
Your Date of Birth
*
Age of Patient
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Who is the Primary Subscriber?
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Self
Spouse
Parent
If you are NOT the Primary Subscriber
Name of the Primary Subscriber
*
Date of Birth of the Primary Subscriber
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Surgeon/Program You Were Referred by
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Submit
By filling out this form you are consenting to be contacted by email/phone. You are consenting to providing your information and for your insurance benefits to be checked.
Please allow 24-48 hours, in a normal business week, for our response.
Services
HPC Team
Bariatrics & Health
Health At Every Size
What Makes Us Different?
Bariatric Services
Non-Surgical Support for Health
Bariatric Support Group-New Dates!
GLP-1/Health-Weight Management Support Group
Contact & Scheduling-Counseling
Contact & Scheduling- Pre-Surgical Eval
Insurance and Payment