Forms to Complete Prior to Your Education Seminar
Thank you for taking the time to attend an upcoming weight-loss surgery patient education seminar, and for your interest in the weight-loss program at Aiken Regional Medical Centers. Your seminar information packet includes a number of educational items and forms.
Download and complete these forms to bring with you when you attend one of the weight-loss surgery information seminars (PDF downloads).
Patient Education Information
- Key Steps to Bariatric Surgery
- Medical Criteria For Bariatric Surgery
- Bariatric Operations
- Bariatric Patient Agreement
- Sample Letter of Medical Necessity
Please complete these forms and return then to the Bariatric Coordinator.
- Medical Intake Form
- Contact Form
- Patient Insurance Information and Verification Form
- Knowledge Assessment Form
- Sleep Apnea Screening Questionnaire
- Psychological Assessment Tools Instruction Form
- BULIT-R Test
- Binge and Restraint Scales
- BPPS Assessment
- BSQ Assessment of Appearance
- Difficulties in Emotion Regulation Scale
- Lifestyle Profile
- Perceived Stress Scale
- Social Situation Test (FNE)
- Social Situation Test (SAD)
Get Started with Weight-Loss Surgery
Call the Bariatric Nurse Navigator today at 803-641-5751.