Medical Weight Loss Program Enrollment Form

Transform Your Medical Weight Loss Program with Smart, Automated Patient Intake

Medical weight loss clinics, bariatric centers, and healthcare providers need more than basic patient forms—they need intelligent intake systems that calculate health metrics automatically, assess patient readiness, and create personalized treatment pathways from the first interaction.

This Medical Weight Loss Program Enrollment Form is purpose-built for healthcare providers offering supervised weight management programs. It combines clinical assessment tools with automated calculations to streamline enrollment while capturing the comprehensive patient data you need for effective, safe treatment planning.

Designed for Healthcare Providers Who Deliver Results

Whether you're running a bariatric clinic, integrative medicine practice, or hospital-based weight management program, this template handles everything from initial health screening to goal-setting in one seamless experience:

• Automatic BMI calculation from height and weight inputs—no manual math, no errors, instant classification
• Metabolic health screening that captures blood pressure, glucose levels, thyroid function, and medication history
• Eating behavior assessment to identify emotional eating patterns, binge behaviors, and dietary triggers
• Personalized goal tracking that documents target weight, timeline expectations, and success metrics
• Medical clearance workflow with conditional questions based on health risk factors

Why Paperform for Medical Weight Loss Intake?

Traditional paper forms create data entry bottlenecks and calculation errors. Generic form builders lack the calculation power and conditional logic needed for clinical assessments. Paperform bridges this gap perfectly:

Smart calculations that work like a clinician thinks: Use built-in calculation fields to automatically compute BMI, ideal body weight ranges, caloric deficits, and weight loss percentages. Patients see their metrics instantly, and you capture accurate baseline data without manual work.

Conditional logic for personalized pathways: Show cardiovascular risk questions only to patients with hypertension. Display diabetes screening for those with elevated glucose. Route high-risk patients directly to physician consultation while fast-tracking appropriate candidates to nutritionist intake.

Professional design that builds trust: Medical decisions start with trust. Create on-brand intake forms that match your clinic's professional image—add your logo, use your color palette, and embed the form directly on your website so patients never feel like they're leaving your care.

HIPAA-conscious workflows with secure automation: While Paperform itself is not HIPAA compliant, you can use it for initial screening and enrollment data, then trigger Stepper workflows to move protected health information into your compliant EHR system automatically. Route new enrollments to your patient coordinator, schedule metabolic testing appointments, and send welcome sequences—all without manual data transfer.

Built for the Weight Loss Healthcare Journey

This template follows clinical best practices for medical weight loss program enrollment:

1. Personal & Contact Information – Standard patient demographics with emergency contact
2. Biometric Data Entry – Height, weight, and waist circumference with automatic BMI calculation
3. Medical History Screening – Cardiovascular conditions, diabetes, thyroid disorders, previous weight loss attempts
4. Current Health Status – Blood pressure, lab values (if available), current medications affecting metabolism
5. Eating Behavior Assessment – Meal patterns, emotional eating triggers, binge eating screening questions
6. Physical Activity Baseline – Current exercise habits, mobility limitations, fitness level
7. Weight Loss Goals & Motivation – Target weight, timeline, primary motivations, previous program experience
8. Program Preferences – Meal replacement options, counseling frequency, group vs. individual preference

Real-World Impact for Healthcare Teams

For physicians and nurse practitioners: Get complete metabolic and behavioral data before the first consultation, allowing you to prepare personalized treatment plans and identify patients who need additional medical workup.

For dietitians and nutritionists: Understand eating patterns, triggers, and previous diet attempts to tailor your counseling approach from day one.

For patient coordinators: Automatically calculate program eligibility, route high-risk cases to medical review, and schedule appropriate first appointments based on patient needs—all from form submission data.

For bariatric surgeons: Screen pre-surgical candidates efficiently, documenting BMI history, comorbidities, and previous weight loss attempts required for insurance authorization.

Automate Your Enrollment Workflow with Stepper

Connect this intake form to Stepper (stepper.io) to create sophisticated patient enrollment workflows without coding:

• Automatic BMI-based routing: Send patients with BMI >40 directly to bariatric surgery consultation, BMI 30-40 to medical weight loss program, and BMI 25-30 to lifestyle modification track
• Lab order generation: Trigger metabolic panel, lipid panel, and HbA1c orders based on screening responses
• CRM and EHR integration: Push new patient data to your practice management system, create charts, and schedule initial appointments
• Multi-touchpoint onboarding: Send pre-program educational materials, medication adjustments, and dietary prep instructions based on each patient's specific protocol

Perfect for Growing Medical Weight Loss Practices

Whether you're a solo practitioner launching a weight management program or a multi-provider clinic scaling your bariatric center, this template grows with you:

• Embed on your website for 24/7 enrollment (no business hours limitations)
• Share via patient portals or email campaigns for existing patients interested in weight management
• Use on tablets in-office for walk-in consultations and health fair screenings
• Customize for specific protocols: Adapt for ketogenic programs, meal replacement plans, medication-assisted weight loss, or pre/post-bariatric surgery protocols

Trust, Compliance, and Security

Healthcare providers trust Paperform for patient-facing forms because of enterprise-grade security features including SOC 2 Type II compliance, data encryption, and robust access controls. For moving data into HIPAA-compliant systems, integrate with Stepper or your EHR via webhooks and secure APIs.

Start Enrolling Smarter Today

Stop struggling with paper forms that delay enrollment and spreadsheet calculations that introduce errors. This Medical Weight Loss Program Enrollment Form delivers the automated, professional patient experience your practice needs—with the clinical rigor your protocols demand.

Join thousands of healthcare providers worldwide who trust Paperform for patient intake, registration, and clinical workflows that just work. Get started today and transform your weight loss program enrollment from administrative burden to competitive advantage.