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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. Springfield Weight Loss Center will help you lose at least 20 pounds of weight loss by the end of your entire program. If you kept all of your appointments and followed the system as detailed in your manual but did not lose at least 20 pounds, you will have your program extended until the total weight loss reaches 20 pounds, with all associated costs paid by Springfield Weight Loss Center.