FirstHealth of the Carolinas

Patient Forms

These are required forms for weight-loss surgery.  You will receive a folder with the same forms the night of the information session.

To help expedite the pre op scheduling process, you may complete the forms in section one prior to the information session and turn them in that night.  Please bring a copy of the front and back of your insurance card to turn in with the forms. 

FirstHealth Bariatric Center does not accept Medicaid or Medicare (with the exception of FirstMedicare Direct, a Medicare Advantage plan offered by FirstCarolinaCare).

We accept all other private insurances.  Coverage is based on the individual policy.

Required FormsPDF

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