Weight Loss Jump Start Program -- Special Living Social Promotion

This area is for the exclusive use of our patient's purchasing our Living Social Physician Supervised Weight Loss Program. Using our online system you will complete the following:

  1. Create your demographic profile as a new patient
  2. Fill our required health history form.  This is needed so that our physician can make the best use of the 30 minute visit and our program guidance is appropriately tailored to you
  3. Read and acknowledge our privacy policies (HIPAA)
  4. Schedule your appointment online

in the event that computers are not your friend and you would prefer to register the old fashioned way, please call the office at (703) 822-5003 Ext 2 to schedule your appointment and make arrangements to fill the paperwork in an alternative manner.  The other choices are:

  1. We can mail you the forms for you to complete and return by mail or fax
  2. We can email you the forms for you to complete either by typing into the forms, printing and faxing the forms
  3. We can email you the forms for you to print, manually fill, then fax or mail to us
  4. You may come to our office and fill the forms in the office PRIOR to your appointment

Note: Whichever method you choose, you must fill the forms PRIOR to your appointment -- no exceptions.  You can not fill the forms on the day of your appointment.  In case of any questions you may email the office at (JavaScript must be enabled to view this email address)

Ready to register and get on your way to getting the pounds off, then click the link below.  The registration process takes just a few minutes.

Here are a few pointers about our online registration process.

  1. You cannot complete this process from a mobile phone.  iPads will work but you will be prompted to download a special application for filling the forms
  2. You must have Adobe Reader installed and it must be the default PDF reader, else you will receive a notification about this.  If you don't have Adobe Reader or aren't sure, click here for the free download from Adobe.  http://get.adobe.com/reader/?promoid=JZEFU
  3. When you get to the payment page, please click the Initial Visit button then select Weight Loss Jump Start Program (Living Social Promo) from the drop down list.

  4. Please complete only one registration for each Living Social purchase as you will need to present a valid coupon on the day of your appointment to redeem your program

 

Now, Click here to continue on to begin the registration process.