New Patient Form Checklist:
To Be Completed and Brought With You on Your First Visit:
- Patient Registration Form
- New Patient Medical History
- Rochester Medical Weight Loss Consent Form
- HIPAA Disclosure Form
Dr. Gule-Rana Masood and the staff of Rochester Medical Weight Loss, P.C. ("RMWL"), welcome you to our weight loss center and look forward to meeting you on your first visit. Dr. Masood and staff work individually with each patient to develop a weight management program designed to best meet the patient's individual goals.
Please note that not all persons seeking medical weight reduction are suitable for the programs offered by our practice. Prior to being accepted as a patient, you will be asked to participate in a short intake interview to determine your suitability for our programs. If accepted, you will be asked to complete the forms indicated below.
PLEASE NOTE THAT WE ARE NOT PRESENTLY ACCEPTING PATIENTS ENROLLED IN MEDICARE. If you are enrolled in either Medicare, please notify our practice coordinator before proceeding further.
RMWL does not contract with any insurance plans (including, without limitation, Health Maintenance Organizations (HMOs), Point of Service Plans (POSs), Preferred Provider Organizations (PPOs) or Preferred Provider Networks (PPNs), and is not a Medicaid provider. Therefore, patients accepted to our practice are personally responsible for payment to RMWL for the services received. Payment is due at the time services are rendered. RMWL will not bill or submit claims to insurance companies or other third party payers.
To help you prepare for your first visit, please print out the new patient packet, complete all of the forms prior to your visit and bring them with you. If you do not have your forms with you on your first visit, you will be required to complete them the morning of your appointment. If you have any questions, please feel free to contact our office at (585) 467-8838.
We look forward to meeting you.
Gule-Rana Masood, M.D.