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Appointments & Forms

Weight ManagementFor Physicians—Making an Appointment

In order to make an appointment in our Weight Management Clinic:

  1. The Primary Care Physician must complete the Physician Referral Form and fax along with insurance referral (Medicaid referrals must be cascading and include current screening date), growth chart, lab work obtained in the last 6 months, and clinic notes to 205-212-2735. Patients over age 18 should be referred to UAB's EatRight program. You may contact UAB EatRight at 205-934-5564. To speed up the process, have the familiy complete the Parent Form in your office and fax along with the referral. Downloadable Physician Referral (PDF) Please complete this form even if demographic sheet is attached.
  2. Please give patient the Orientation Instructions.
    *We will not schedule the intitial appointment in our clinic without completion of orientaton and ALL paperwork received in our office .
    *PLEASE DO NOT FAX PARENT FORMS. ALL families must complete orientation. After orientation is complete, an Individual New Patient Appointment will be scheduled. At this visit your child will be seen by several healthcare professionals including a pediatrician, a registered dietician, a physical therapist and a pediatric psychologisit. Please call our office at 205-638-5750 if you are unable to complete orientation online.
  3. Once ALL paperwork is received, the patient will be scheduled in first available slot. Information concerning appointment will be mailed to the family and appointment date/time faxed to referring physician. (Please make sure that we have the correct mailing address and contact number for the families)

For Patients

Printable Forms Please use the below forms to help complete the orientation process to our clinic:

Instructions for Online Orientation
Orientation Post Test (must be completed after online orientation)
Parent Form (must be completed after orientation and received in our office prior to Individual New Patient Appointment)
Parent Form (Spanish)
Adolescent Form (12 years & up) (must be completed after orientation) You may mail this form with the parent form or bring with you to first appointment.
Stop Light Diet
Stop Light Diet/Spanish
The Road to Healthy Eating
The Road to Healthy Eating/Spanish
Food and Activity Log (Please complete this log and bring with you to ALL Appointments)
Food and Activity Log (Spanish)


Orientation Class

The Orientation Post-Test and Parent Form must be completed and mailed to our office before an individual new patient appointment will be scheduled. (Please do not fax forms) In addition to the Parent Form, patients 12 years old and up must also complete and return the Adolescent Form. Please print out the food and activity log, complete at home and bring to ALL appointments.

Click below to view orientation:
Orientation Online Video
Questions? Email us at ccwm@childrensal.org

Mailing address:
Children's South
Children's Center For Weight Managment
1940 Elmer J. Bissell Rd
Birmingham, AL 35243

PLEASE DO NOT FAX PARENT FORMS and Adolescent forms.




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