Bariatric Program Checklist

Complete each step in order, numbers 1-5.

You have the convenient option of completing your pre-operative nutrition program close to home at Thompson Hospital where parking is free. 

Please read through this checklist to help you navigate the requirements. Once all of these items have been completed each step in order: 1-5, you will be ready for your Primary Care Providers referral so you can register for the Group Nutrition Seminar at Thompson Health.

  1. Call your insurance carrier to confirm what coverage you have for Bariatric Surgery AND Nutrition Counseling.  
  2. If you have not already done so: call the Highland Bariatric Center at 585-341-0366 to see if you qualify for bariatric surgery.  After you are screened as qualified- go to the website ( to print all the *required forms.  
  3. Make an appointment with your Primary Care Physician (PCP) to complete the *Primary Care Form. Make sure the weight loss section on the *Primary Care Form is complete with the year(s) you followed the weight loss program and the number of months you followed the program. Please have your Primary Care Physician fax the completed PCP form to: 585-341-0215 AND to: 585-396-6915.
  4. Complete the *Bariatric Surgery Questionnaire (questionnaire is also available to complete online through My Chart) and either  
    I. Fax to 585-341-0215 or 
    II. Mail to Highland Hospital, Department of Surgery, c/o Bariatric Questionnaire, 1000 South Avenue-  Box 95, Rochester, NY 14620, or 
    III. Complete the Bariatric Surgery Questionnaire and turn-in prior to leaving. 
  5. Once your Bariatric Surgery Questionnaire is received the Bariatric Center will contact you to make your first medical appointment at Highland.   
    a. Please bring a list of your medications to your medical appointment at Highland.
    b. Inform the Bariatric Center if you want to obtain your nutrition requirements at Thompson Health
  6. Once your PCP has sent the referral to Thompson, call scheduling at 585-396-6433 to register for a Group Nutrition Seminar.

* = Required Highland Bariatric Center forms, available on the website:

Contact Linda Rowsick, RD, CD-N for any questions via email at:


Specific questions regarding charges can be directed to the Priceline at 585-396-6194Note: if you do not have insurance coverage for nutrition counseling, the Priceline can assist you with applying for financial assistance.

The Group Nutrition Classes are held monthly at Thompson Health. You are welcome to bring one (1) support person to the class and ALL appointments.

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