Physician Supervised Diet & Exercise Counseling


Many insurance programs now require patients to participate in a physician supervised diet and exercise counseling program prior to surgery.  Each insurance company and plan has different requirements. Our Bariatric Initial Coordinator will walk you through this process during your first visit in our office.

For your convenience, we have uploaded the necessary form to our website. Please print out and take with you to your physician’s office or share the link with your physician’s staff.  The form must be filled out in it’s entirety and signed by the provider.

If you have any questions about the supervised diet and exercise counseling portion of your preoperative workup, please call our office at 919-234-4468 and ask to speak with your case manager.

Click here to access:   Diet & Exercise Counseling Form

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