Lose the Weight and

Gain Back Your Life!

  • Center of Excellence in Metabolic & Bariatric Surgery
  • Master Surgeon in Metabolic & Bariatric Surgery
  • Surgeon of Excellence in Metabolic & Bariatric Surgery

Patient Forms

Prepare Your Form and Records Ahead of Time

Dr. Kuzinkovas and his team respect your busy timetable. We have designed this page to help minimize any unnecessary waiting time filling out the forms. We would like to focus on you rather than paperwork. To help us do this, when you come in for a personal consultation – please fill out and bring the following form and records to your appointment.

Please Bring The Following Items With You To Your Appointment:

  • Print and complete the form shown below
  • Bring it with you to your appointment
  • Bring your Medicare and Insurance cards to each appointment
  • Bring all your available records and test results (results of your blood tests, X-rays, CT scans, MRI scans, etc), prescriptions and over-the-counter medication that you are currently taking
  • A list of all questions and/or concerns that you may have
  • If you have any questions – please call us on: 1300 551 533

New Patient FormNew Patient Information Form

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