Forms
Feel free to download the forms below. To begin your process, complete the Patient Profile Packet, the Eating Questionnaire and the Insurance Review Form and mail to us, along with a copy of your insurance card(s), front and back, to:
Georgetown Bariatrics
1140 Lexington Road, Ste. 230
Georgetown, KY 40324
You may also fax those to us at: 502-570-3719
Note: If you have Medicaid or Medicare (without supplement), you do not need to complete the Insurance Review Form, but we must have your Patient Profile Packet and a copy of your Medicaid and/or Medicare card(s). Additionally, it will take four (4) stamps to insure the forms are delivered promptly and not held at the post office for lack of postage.
Insurance Review Form
This form will help you determine if your insurance policy covers weight loss surgery.
Self-Pay Pricing
If your insurance doesn't provide Bariatric Surgery benefits, please refer to this form. Please note that this form does not include pre-op labs and other tests, as those are determined on an individual basis.
Patient Profile Packet
Print, complete, and get this form back to us to officially start your process!