Download Evaluation Forms and Instructions:

Before televideo meetings, please click on the #1 Combined New Patient Information form, or use the #2 Televideo consent form only (for Dr. Azrin or Dr. Millsaps) if you have already filled out the New Patient Information form.

Please click on the Release to give us a release to contact your referral doctor, other doctors, or any family/friends you would like us to be able to speak to:

#1 Combined New Patient Information, Release of Information, and Televideo consent

#2 Dr.  Azrin Televideo Consent form only
#2 Dr. Millsaps Televideo Consent form only

Release of Information Form Only

Gastric Bypass, Lap Band, and Gastric Sleeve Evaluations


Neuropsychological Evaluations


Psychological Evaluations


Dementia / Alzheimer's Evaluations


Evaluations of Children and Adolescents

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* Forms for providers may be found on that providers page