Bariatric Program Checklist

Complete each step in order, numbers 1-8.

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: 1-8, you will be ready for your consultation with the surgeon.

    1. Call your insurance carrier to confirm what coverage you have for Bariatric Surgery AND Nutrition Counseling.

    2. Call 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. Attend a Bariatric Seminar or view the Bariatric Seminar on line at the Highland Bariatric Center website.

    4. 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.

    5. Complete the *Bariatric Surgery Questionnaire and either 1.) Fax to 585-341-0215 or 2.) Mail to Highland Hospital, Department of Surgery, c/o Bariatric Questionnaire, 1000 South Avenue, Box 95, Rochester, NY 14620. (This is also available to complete online through My Chart.)

    6. Once your completed Bariatric Surgery Questionnaire is received, the Bariatric Center will call to make your first medical appointment. Please bring a list of your medications to your medical appointment. 

    7. Ask your Primary Care Physician to fax this referral for Bariatric Nutrition Counseling to Scheduling at: 585-396-6492. A referral is required by the center even if your insurance does not.

    8. AFTER completing steps 1-7 above, call Thompson Health System Scheduling at 585-396-6433 to register for the Group Nutrition Class.
      1. 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.
      2. 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.


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