Illinois Bariatric Center

Our Forms

Please click on the link below to download a copy before your first visit.

These forms are provided here in an electronic format for your convenience. All of this information will give our staff an overview of your current and past personal medical history. Insurance companies rely heavily on this information, especially the Diet History, for approval of surgery. Please print and carefully complete the forms below. Bring the completed forms along with any insurance information to your initial consult with Dr. Rohrscheib.

Registration Forms