Congratulations!

Welcome to Your New Future!

By scheduling your appointment with us, you have taken the most important first step. If you have a printer, here is the perfect way to save time on your first visit.

Using Adobe Reader, print out and then fill in the following forms:

motivation
12 reasons why
I want to lose weight		 new patient form
Patient Information		 patient medical history
Medical History

Bring the forms with you on your first scheduled appointment. If you do not have a scheduled appointment, please call the clinic and schedule your appointment today. Call for appointment: 718-491-5525

Thank you for choosing New York Weight Loss Center. You will love the new you!

Motivation is an important ingredient

YOUR 12 Reasons

“Why I Want to Reach My Goal Weight”

Name:

Date:

Before writing your reasons down, give them some thought. It is important that these 12 reasons be true personal goals and desires. They should not be generalizations or what you think would please others because they will be used as your “personal motivator.”

Take a few moments from time to time each day to thoughtfully read through this list. This is called mental programming. The original of your 12 reasons list is retained in your medical file. You will be given a copy to carry at all times. We suggest that you also transfer your list onto a 3 x 5 card which may be more convenient.

Make a promise to yourself now: “I will read the entire card whenever I am confronted with a difficult food situation.” Reading the list will clearly reinforce your personal commitment to take control of your health and self-esteem.

1. 5. 9.
2. 6. 10.
3. 7. 11.
4. 8. 12.

More information about personal Weight Loss Motivation

Read what others have said about successful weight loss with our help.

Free Online Patient Tools

Please feel free to use our free online patient tools available to you right here on WeightLossNYC.com, including our online calorie calculator and nutritional info database, obesity risk calculator, and BlackBerry® “Weight Loss Assistant” app — all free.

Office Contact Information

Address: New York Medical Weight Loss Center, 7032 4th Avenue, Brooklyn NY 11209
Phone: 718-491-5525

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Medical Weight Loss New Patient Forms and Information for Your First Visit

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