Patient’s Downloadable Entry Form

Patient Questionnaire

Dear Prospective Patient:

Thank you for your interest in our Bariatric Surgery Program. We offer comprehensive Pre-operative and Post-operative care, provided by a multidisciplinary team of excellent compassionate professionals. We strive to maximize your success with weight loss and improvement of associated medical conditions. We offer the Lap-Band, the laparoscopic Sleeve Gastrectomy, and the Roux-en-Y Gastric Bypass procedures. As of 2018 Tri State Bariatrics has performed over 8000 bariatric surgeries.

Thank you for scheduling an appointment at Tri State Bariatrics. Once you have scheduled an appointment we request you take time before your appointment to print off and fill out the “Patient Questionnaire” , unless you have accessed your Patient Portal and answered the questions already.

Photo of Patient ‘s Questionnaire
Patient ‘s Questionnaire

At your first appointment please bring this completed “Patient Questionnaire” with you. You will be meeting with many of our staff members at this first appointment who will use this important information.

At your first visit several staff members will be meeting with you on a one on one basis. You will meet with our Nurse Practitioner who will complete a thorough history and physical. A Registered Dietitian will discuss in detail your previous diets and provide to you information about food choices. The Registered Nurse will explain the surgical options and provide you with written education materials. Our Insurance Liaison will affirm bariatric coverage under your insurance plan. Then you will meet with our Patient Navigator who will provide to you a step by step guideline about the pre-operative tests and consults that are needed prior to scheduling your surgery.

Office Locations:

Suffern, NY
156 Route 59, Suite A2, Suffern, NY 10901

Middletown, NY
384 Crystal Run Road, Suite 201, Middletown, NY 10941

Fishkill, NY
200 Westage Business Center, Suite 119, Fishkill, NY 12524

Sleepy Hollow, NY
777 North Broadway, Suite 207, Sleepy Hollow, NY 10510