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Appointments & Forms

 For Physician

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

The first appointment to our clinic is an Orientation Class which may be completed online.  ALL parents and children 12 & older 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.

1)     The Primary Care Physician must complete the Physician Referral Form and fax along with insurance referral (Medicaid referrals must be cascading), 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.

Downloadable Physician Referral (PDF ) Please complete this form even if demographic sheet is attached.

2)     Please give patient the Orientation Instructions. Following the referral from the Primary Care Physician, the patient's legal guardian and children 12 & older must complete orientation. ***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.

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 Patient

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 prior to Individual New Patient Appointment)

Parent Form (Spanish)

Adolescent Form (12 years & up) (must be completed after orientation and prior to Individual New Patient 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 Class

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

                                                                                                                                                                      

 




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