---
title: Medical Weight Loss Program Consent Form Template | Paperform
description: Complete consent form for medical weight loss programs with prescription medications, nutritional counseling, exercise plans, and monthly monitoring. HIPAA compliant template.
url: "https://paperform.co/templates/medical-weight-loss-program-consent-authorization"
type: static
generatedAt: "2026-03-28T00:44:30.134Z"
---

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

Starting a medical weight loss program is an important step toward better health, and proper documentation is essential for patient safety and regulatory compliance. This **Medical Weight Loss Program Consent & Authorization** template helps healthcare providers, weight loss clinics, and wellness centers gather comprehensive patient information, obtain informed consent, and ensure HIPAA compliance—all in one professional, easy-to-complete form.

#### Built for weight loss clinics and medical practices

Whether you're running a dedicated weight loss clinic, adding medical weight management to your primary care practice, or operating a wellness center with prescription medication programs, this template streamlines the intake and consent process. It captures essential medical history, current medications, treatment preferences, and all necessary authorizations while maintaining a clear, patient-friendly experience.

The form is structured to guide patients through:

 - Personal and emergency contact information
 - Comprehensive medical history and current health status
 - Treatment options including prescription medication preferences
 - Nutritional counseling and exercise program consent
 - Monthly monitoring requirements and expectations
 - HIPAA authorization and release of information
 - Program policies and financial responsibility

#### Automate your weight loss program workflow

With Paperform's built-in integrations, this consent form becomes the foundation of your entire patient management workflow. Connect submissions directly to your EHR system, send welcome packets automatically, schedule initial consultations, and trigger follow-up appointment reminders.

Take automation further with **[Stepper](https://stepper.io)**, Paperform's AI-native workflow builder. Create sophisticated patient onboarding sequences that route submissions to different providers based on BMI or medication eligibility, automatically schedule nutritional counseling sessions, send monthly check-in forms, and keep your team coordinated throughout each patient's weight loss journey.

For programs requiring signed consent forms for controlled medications or treatment agreements, integrate **[Papersign](https://papersign.com)** to convert submissions into legally binding eSignature documents that patients can review and sign digitally, with everything linked back to the original intake form for complete record-keeping.

#### Professional, compliant, and easy to customize

This template includes conditional logic to show relevant medication options only to eligible candidates, collect appropriate medical history based on treatment selection, and ensure all required fields are completed before submission. The form maintains a professional, reassuring tone that helps patients feel confident about their decision to pursue medical weight loss.

Customize the template to match your practice's specific protocols, add your clinic's branding, modify medication options to reflect your formulary, and adjust monitoring requirements to align with your clinical approach. With Paperform's doc-style editor, you can make these changes in minutes without any technical expertise.

Trusted by healthcare providers nationwide, this form template helps you deliver a modern, compliant patient experience while reducing administrative burden and ensuring you have all the information needed to provide safe, effective weight loss treatment.
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