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eVisit Registration

EXPRESS WEIGHT LOSS CLINIC
Non-surgical medical weight management
eVisit Patient Registration
A $25 deposit is required to schedule a reserved appointment time. Payment information will be collected upon the completion of online forms.
The $25 required deposit will be waived in the event of a previously funded yet unused deposit.
FAILURE TO USE THE CORRECT spelling of your first and last name, as well as your documented date of birth, will result in the inability to schedule an appointment online.

Deposit FAQs

  • question_answer Why are we collecting a deposit?
    Once you make an appointment that date and time is blocked for you alone. Another person cannot book an appointment for the same date and time that you have reserved. Once you have made a reservation, we must schedule staff members to be available to see you at that time. If at the last moment you fail to show up for your appointment, no other person has time to fill your date and time reservation, yet we still incur staffing cost. This is not fair to other patients that would have wanted to be seen during the appointment date and time that you reserved. It also creates an unfair financial burden to our company.
  • question_answer What happens to my deposit?
    If you show up for your scheduled appointment, your deposit will be applied towards your visit's expense.
  • question_answer Under what circumstances would I lose my deposit?
    If you fail to show up to your scheduled appointment date and time, you will lose your deposit. If you fail to have ALL of the necessary equipment (Photo ID, Digital Blood Pressure Cuff, and scale), then you forfeit your deposit. Please note that we monitor prescription controlled substances and that we CANNOT prescribe appetite suppressants if you are actively taking any medications for ADD/ADHD.
  • question_answer Under what circumstances can I get my deposit refunded to me?
    If you cancel or reschedule your appointment date and time more than 72 hours prior to your reserved date and time appointment, your deposit will be refunded to you or applied towards your new scheduled appointment date and time. If, however, you reschedule or cancel your appointment three times in a row, you will lose your deposit regardless of how far out you cancelled or rescheduled the appointment.

eVisit Form

Selecting a state serves as an acknowledgement that I will be located in the selected state at the time of my eVisit.

Regulations prevent prescribing appetite suppressants via telemedicine in the state that you selected. We apologize for any inconvenience.

Patient Information

Patient Name *

Patient Information

Gender *

Medical History

Physical Activity

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*
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Non-surgical medical weight management

EXPRESS WEIGHT LOSS CLINIC

Acknowledgement: *
Use your mouse or finger to draw your signature above
Clear

Prepare for eVisit Checklist

Please make sure you use the calendar scheduler after you submit the eVisit form. If you do not schedule an appointment you will not be seen. Thanks.

Please make sure you are prepared with the following items prior to your scheduled eVisit time:
  • Government-issued driver's license or ID
  • Form of payment (Visa, Mastercard, AMEX, Discover)
  • Scale
  • Electronic blood pressure cuff
  • Web cam or video-enabled smart device

Payment Information

Enter your card information: *

Click submit below to be routed to our NEW scheduling page. You have to schedule using the calendar to be seen via eVisit

For downloadable versions of these forms and waivers, please visit our Forms Page