Referral Information
Referral Form
Please use this form to submit referrals to our office. For any questions, contact our office at 515-241-2250.
As the patient's Primary Care Physician, here are some things you can do to help your patient:
- Have documented participation in at least six months of medically-supervised attempts at weight management with documented weights over that time period
- Have a documented BMI ≥ 35 with serious obesity-related co morbidities, or have a documented BMI ≥ 40
- Documented Obesity-related co morbidities include:
- Type II Diabetes Mellitus
- Sleep Apnea
- Pseudotumor cerebri
- Hypertension
- Dyslipidemias
- Non-alcoholic steatohepatitis
- Venous stasis disease
- Polycystic Ovary Syndrome
- Intertriginous soft tissue infections
- Stress Urinary Incontinence
- Gastroesophageal Reflux Disease
- Weight-related arthropathies which impair physical activity