Patient Forms and Insurance

Patient Registration Form

First time patients or established patients in need of an update can complete this form online prior to your scheduled visit.

Patient HIPAA Form

This notice describes how medical information about you may be used or disclosed as well as how you can access this information.

Upload your Divers License and Insurance Cards

Please us this form to securly upload your drivers license and insurance cards.

Upload your patient health history

Please us this form to securly upload your patient health history.

Submit your nutrition health history

Please us this form to securly upload your nutrition health history.

Complete your 7 Day Meal and Snack Record

Please us this form to securly upload 7 Day Meal and Snack Record.

Insurance Coverage

The Wellness and Weight Management Center is an in-network provider for weight loss and wellness services for Public Employee Benefit Planners* (PEBP) and Hometown Health Plan (HHP).

We also have contracts with most major insurance providers. Call (775) 784-4474 to have our office verify your benefits. Self-pay options are also available.

Public Employees Benefit Program (PEBP)

Services in our weight loss programs are covered under the PEBP Obesity and Overweight Care Management program. See the PEBP 2016 Master Plan Document for details or call our front office at (775) 784-4474.

In order to qualify for the Obesity and Overweight Care Management Program you must first register for the Prevention Plan and complete your Health Risk Appraisal online:

  1. Go to the PEBP website and find the orange "Log-in" button on the top right of the homepage. Login following the directions on the page.
  2. Then go to the Healthscope Benefits page through a button on the right side of that page. It will automatically log into the HSB site.
  3. On the right side of this page is "Documents and Forms" button. Click that and look for the three Obesity Care Management (OCM) forms in that list. To include: How to enroll in the PEBP Obesity and Overweight care management program, OCM Initial Evaluation form for the Dr., and the list of OCM program providers.