---
title: Medical Weight Loss Program Consent Form Template | Paperform
description: Professional consent form template for medical weight loss programs with prescription medication options, nutritional counseling protocols, exercise requirements, and monthly monitoring schedules.
url: "https://paperform.co/templates/medical-weight-loss-program-consent-authorization-form"
type: static
generatedAt: "2026-03-28T00:44:30.129Z"
---

[← Back to free form templates](/templates/)    ![Medical Weight Loss Program Consent & Authorization Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/medical-weight-loss-program-consent-authorization-form.png)
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### Medical Weight Loss Program Consent & Authorization Form

Starting a medical weight loss program is an important decision that requires clear communication between healthcare providers and patients. This **Medical Weight Loss Program Consent & Authorization Form** provides a comprehensive framework for clinics, weight management centers, and healthcare practices offering supervised weight loss services with prescription medications, nutritional counseling, and ongoing monitoring.

#### Built for Healthcare Providers Managing Weight Loss Programs

This template is designed for **endocrinologists, bariatric specialists, primary care physicians, and weight management clinics** that need to obtain informed consent while documenting patient understanding of treatment protocols, medication options, lifestyle requirements, and monitoring schedules.

The form walks patients through essential program components including prescription medication risks and benefits, nutritional counseling expectations, exercise protocols, monthly check-in requirements, and authorization for communication between care team members. Conditional logic ensures patients receive relevant information based on their specific treatment path.

#### Streamline Patient Onboarding with Paperform

Instead of managing paper consent forms and manual filing systems, this Paperform template lets you collect digital consent with secure eSignature capabilities through **[Papersign](https://papersign.com)**. Patients can complete the form before their first appointment, automatically generating signed consent documents for your EMR system.

Connect the form to your practice management software via **[Stepper](https://stepper.io)** to automatically schedule follow-up appointments, send pre-appointment questionnaires, trigger nutritional counseling bookings, and maintain HIPAA-compliant records. Integration with tools like Google Calendar, Acuity, or your existing scheduling system means less administrative work and more time focused on patient care.

#### Professional, Compliant, and Patient-Centered

This template maintains a professional medical tone while remaining approachable and easy to understand for patients. It covers essential medical consent elements, HIPAA authorization language, emergency contact information, and insurance details—all while ensuring patients feel informed and supported throughout their weight loss journey.

While this form provides a strong foundation for medical weight loss program consent, it should be reviewed by your legal counsel and compliance team to ensure it meets your state's specific requirements and your practice's protocols. Paperform is not HIPAA compliant, so please ensure you're using appropriate security measures for protected health information.
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