Refer a Patient

Dear Healthcare Provider,
Whether you’re:

an orthopedic surgeon with a patient scheduled for joint replacement, who needs to lose weight prior to surgery
a primary-care physician who has a gastric band patient who is having problems
an nurse-practitioner with a patient who has diabetes and needs to lose weight

we are happy to assist you in any way!Just fill out the form below and one of our patient-service representatives will contact the patient as soon as possible!

Sincerely,
Dr. Trace Curry
Medical Director
JourneyLite Physicians

Refer A Patient To JourneyLite Physicians

Refer a patient to us here!

Patient Name*
First Last
Patient Email (optional)
Enter Email Confirm Email
Contact Number*
Referring Provider's Name*
First Last Suffix
Referring Provider's Contact Number*
Referring Provider's Fax Number*
I am referring this patient for:*
- Medical weight loss (phentermine, Qsymia, Belviq, etc)
- Surgical weight loss (gastric sleeve, bypass, etc)
- Non-surgical weight loss procedures (gastric balloon, ESG, etc)
- Pre-op weight loss for orthopedic, spine, or other surgery
- GERD treatment options
- Other-specify below
Your Message
Comments
This field is for validation purposes and should be left unchanged.

One thought on “Refer a Patient”

56 year old male w/ bmi: 37.02, chronic health conditions include DMII, htn, hyperlipidemia, and osa, and would benefit from possible wt loss procedure

Refer A Patient To JourneyLite Physicians

One thought on “Refer a Patient”

Leave a Reply Cancel reply