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.
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
Please complete this form and send back to us along with your Insurance Review Form and copy of the front and back of your insurance card.
Weight Loss Surgery Manual
This is the manual that all of our patients recieve upon their first appointment with us here at Georgetown Bariatrics. Feel free to print this off on your own if you would like.
Insurance Review Form - 2013
You must complete this form for all commercial insurance plans. More details are printed on the form itself. Please call if you have questions.