At the Center for Digestive & Metabolic Surgery we provide minimally invasive solutions for complex metabolic & digestive disorders.

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Patient Forms

To save time during your appointment, you can fill out these forms at home and then bring them with you.

Dr. Daryl D. Wier

• New Patient General Surgery Form
• New Patient Bariatric (weight loss) Form
• Appointment Slip and Checklist
• Seminar Registration Demographic Form

Please note: These documents are in Adobe® PDF format. They require Adobe Reader to be viewed. If you do not have Adobe Reader, you can download it for free by clicking here.

 

YOU MUST BRING WITH YOU THE FOLLOWING ITEMS:

• All required forms filled out entirely

• Photo identification for the patient

• All actual insurance cards. If you have Secondary Insurance and do not provide us with the card, we will not be able to bill this insurance.

• If your insurance requires an AUTHORIZATION or a REFERRAL in order for you to see a Specialist (Dr. Wier is a Specialists), it is your responsibility to get the authorization or referral and bring it with you to your visit. We will not be able to see you without it.

• Bring all of your test results with you. We are not able to obtain your test results, films, studies, scans or reports. Please get these from the doctor or doctors who have referred you, or where you had the test done. It is the patient’s responsibility to bring all test results with them.

 

Services

• Achalasia
• Bariatric (weight loss) Surgery
• Biliary/Gallbladder Surgery
• Colon Surgery
• Hernia Repair
• Gastroesophageal Reflux Disease (GERD)
• Small Bowel Surgery
• Splenectomy
• Thyroid Surgery