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New Patient Paperwork

Springfield Weight Loss Center offers our patient form(s) online so they can be completed in the convenience of your own home or office.

  • All forms are PDF files. You will need AdobeReader® to view them.
  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print them out and fill in the required information.
  • Fax us your printed and completed form(s) or bring them with you to your appointment.

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Are You Ready For The Results You Deserve?

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Springfield Weight Loss Center
1229 South 6th Street Suite B
Springfield, IL 62703
(217) 544-4001

OFFICE HOURS
Monday9:00 am - 6:00pm
Tuesday9:00 am - 6:00pm
Wednesday9:00 am - 6:00pm
ThursdayClosed
Friday9:00 am - 6:00pm
SaturdayClosed
SundayClosed

*Although results may vary, those who follow the program have an extremely high success rate.