Bariatric Surgery Patient Intake Form

Bariatric surgery is a life-changing procedure that requires thorough patient evaluation and preparation. This Bariatric Surgery Patient Intake Form template helps surgical practices, weight loss centers, and hospitals efficiently collect essential patient information during the initial consultation phase.

Designed specifically for bariatric surgery programs, this form captures critical data including comprehensive weight history, previous diet and exercise attempts, obesity-related comorbidities, psychological readiness, and lifestyle factors. Healthcare providers can use this information to determine surgical candidacy, plan appropriate interventions, and ensure patients are fully prepared for the transformative journey ahead.

Paperform makes bariatric patient intake seamless. Create on-brand forms that patients can complete from any device before their appointment, reducing wait times and improving data accuracy. Conditional logic ensures patients only see relevant questions based on their responses, while secure data collection keeps sensitive health information protected with SOC 2 Type II compliance.

Connect your form to your electronic health records system, CRM, or project management tools using Stepper (stepper.io) to automatically create patient files, trigger follow-up workflows, schedule consultations, and notify your care team when new intakes arrive. With Paperform's calculation fields, you can even compute BMI automatically and route patients to appropriate care pathways based on their surgical eligibility.

Whether you're a bariatric surgeon, weight loss clinic, or hospital surgical department, this template provides a professional, comprehensive foundation for gathering the detailed patient information needed to deliver exceptional bariatric care and achieve optimal surgical outcomes.