Criteria 
 
 
 
 

 

•  BMI of 40 or greater consistent for the past five years. 
    (To calculate your BMI, click HERE)

 


•  BMI of 35 or greater with any of the medically treated co-morbidities listed: 
        Diabetes 
        Hypertension 
        Sleep Apnea 
        (insurance requirements may vary)  

•  Failure of other measures to lose weight, such as: 
        Medications 
        Weight Loss Programs
        Dietary Changes  

•  Acceptable surgical risk  

•  Ability to understand lifestyle changes and motivation to comply with program guidelines.  

•  Absence of medical/psychological contraindications

 

To better determine if surgical weight loss is right for you, please fill out this screening questionnaire. Completed forms can be emailed directly to our office by clicking on the "Submit Form by Email" button at the top of the page, or you can print and mail the questionnaire to our office at the address listed below.

 

 

 

Frye Regional Medical Center Surgical
Weight Loss Referral Procedure
 
  
 

Once we identify a patient as an appropriate candidate for Bariatric Surgery, the documentation listed below is required for insurance approval.  This also ensures patients meet National Institutes of Health and American Society for Bariatric Surgery criteria for Bariatric surgery.  

 We schedule an education class after we review your completed Health Assessment questionnaire.  

 You should begin gathering the following necessary information.  Once our office has received and reviewed ALL the information, we send your chart to the surgeons's office for processing.  The office will then contact you to schedule an appointment for a History and Physical with the surgeon.   

  1. Letter of referral from your primary physician or gynecologist
  2. Medical documentation, including office visit notes and weights for the past five years (copy for SWL Clinic/copy for psychological evaluator).  
  3. Recent “normal” thyroid panel (Must be within 6 months of surgery).  
  4. Psychological evaluation
  5. Complete physical from your primary physician or gynecologist (Must be within 12 months of surgery).    

 Please have the above documentation faxed to our office at (828) 315-5950.  You may also mail the information to the address below.  If you have any questions, please contact the Frye Surgical Weight Loss Program at (828) 315-5577 or toll free at
1-866-720-5577.  

Frye Regional Medical Center Surgical Weight Loss Program
415 North Center Street, Suite 003
Hickory, NC 28601