Physician Referrals

How do I help my patient get started?

  • Complete the appropriate Consultation Orders for Bariatric Patient Evaluations form and fax to our office at 217-527–3209.
  • Fax documentation of a recent Health & Physical Exam (completed within the past 6 months) to our office with the consultation order.
  • Provide your patient with our program brochure and encourage him or her register for an orientation online at
  • If your patient does not have internet access, he or she can call our office at (866) 205–7915.

Who is a candidate for surgery in our program?

  • Patient is 18–70 years old
  • Patient has a Body Mass Index (BMI) between 40–70 — or greater than or equal to 35 and accompanied by at least two medical conditions such as a sleep disorder/CPAP usage; Type 2 diabetes mellitus; heart disease; hyperlipidemia; or hypertension
  • Patient is motivated and willing to work with a multidisciplinary team
  • Patient is deemed an acceptable risk for surgery. The initial medical screening at enrollment should reveal that the patient is able to ambulate at least 25 feet and does not require home oxygen use, and not surpass the above-mentioned age and BMI criteria.

What should your patients know about weight-loss surgery?

  • Weight-loss surgery is not a “magic bullet,” but rather a tool to help with lifestyle modifications involving proper nutrition and physical activity.
  • For patients with co-morbidities such as type 2 diabetes or sleep apnea, these conditions may improve or even resolve as a result of significant weight loss following surgery.
  • Patients should call their insurance company to inquire about insurance coverage.

How do I help my patient in the pre-operative process?

  • Schedule monthly visits of medically supervised weight loss (MSWL) with your patient to meet insurance requirements, reinforce dietary and exercise changes, and record weight status. Download the MSWL checklists.
  • Document obesity-related co-morbidities and their progression to help prove medical necessity.

Thank you for referring your patient to Memorial Bariatric Services. We will keep you informed with the status of your patients in our program. If you have any questions, please feel free to contact us at 866-205–7915 or email us at