CYPRESS PHYSICIANS ASSOCIATION

(281) 537-0300

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Weight Loss Questionnaire

Cypress Physicians Association
Weight Loss Questionnaire

It is with the greatest pleasure that we welcome you to the Cypress Physician Association. On behalf of our team of professionals, we thank you for choosing us and look forward to partnering with you on your weight loss journey. It is our mission to provide an evidence-based approach to weight loss and customize an individualized treatment plan for you.
To expedite your appointment, we have enclosed a health questionnaire that will provide us vital information and ask that you bring this completed to your first visit. We also ask that you allow plenty of time to get to the office for your appointment. You may be asked to reschedule your appointment if the below paperwork is not completed. The paper work should be filled out to the best of your knowledge due to a customized plan being made from information provided. Though follow up visits are around 15 minutes, please allow for one hour for your first visit to account for initial evaluation, EKG, and lab work.
If there are any questions prior to the first appointment please contact us at 281-537-0300.
Thank you and we look forward to working with you on this important decision you’ve made to
live a healthier life.
Respectfully,
Elizabeth Couch FNP-C

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