Weight Loss Forms & Instructions
These are Forms and Instructions that are needed for all JSAPA Bariatric and Weight Loss Procedures. Our forms section provides you with forms to download and complete before visiting our office. Completing these forms before your visit will save you time and ensure that you have all of the necessary documents available for our medical team to review.
- Patient Registration
JSAPA new patient information form - Allergies & Medications Form
Please list all allergies and medications on this form. - C Financial Policy
JSAPA Weight Loss Financial Policy - HIPAA notice
JSAPA Privacy and HIPAA compliance policy - Medical Release
Authorization for release of medical records to other agencies - Patient Responsibility Form
JSAPA Patient Responsibility Agreement - Media Release Form
Consent for taking and publishing photographs - Malpractice Insurance Notice
By law, all physicians practicing in the state of Florida must notify their patients if they do NOT carry malpractice insurance.
Our Bariatric Approach
Surgery (balloons, bands, sleeves, bypasses) is simply the most powerful form of total caloric reduction resulting in the most consistent powerful form of weight loss. So, patients typically lose a massive amount of weight because these devices or surgeries induces a state where you do not feel hungry, eat small amounts of food and lose a lot of weight because of calorie reduction. However, the effective durability of weight loss because of the surgery is only not permanent unless you understand and address why you gained the weight in the first place. This is more complex than it may seem. This is where the JSAPA model differs from most bariatric practices. We desire much more for our patients. Surgery is not the easy way out, it may be lifesaving necessary as a last resort, but ultimately it is addressing CAUSE that matters.
JSAPA uses a substance abuse cognitive behavioral carbohydrate addiction methodology to treat our patients into remission from diabetes, obesity and many of the other co-morbidities.
Learn more about Weight Loss Surgery at JSAPA
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SUCCESS STORIES
From Dr. Robert Cywes's Blog
Weight Loss Testimonials and Tips
Jackie: LAP-BAND Success
I've lost 115 lbs.- This was the best decision of my life - I'm no longer a med-dependent diabetic. I can say I'm healthy and very happy - I am able to do things I've never been able to do!
Read More Sue: LAP-BAND Success
For as long as I can remember, I have been on a diet. Cabbage soup, cookies, starvation - nothing ever seemed enough or made me want to stay on it long term. Just over a year ago, I discovered the.
Read More Gastric Band Surgery for Obese Children
Obesity tends to run in families. Oftentimes, children of overweight or obese parents will find themselves suffering from the same weight problems as their parents did before them.
Read More