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  • The Groundwork of all happiness is Health

    -Leigh Hunt

  • Every Step is Towards the Healthier Life

  • Shed Calories, Stay Fit... Secrets of Healthy Life

Patient Forms

Prepare Your Form and Records Ahead of Time.

Sydney weight loss surgeon Dr. Kuzinkovas and his team respect your busy timetable. We have designed this page to help minimize any unnecessary waiting time filling out the forms. We would like to focus on you rather than paperwork. To help us do this, when you come in for a personal consultation - please fill out and bring the following form and records to your appointment.

You will need to bring the following items with you to your appointment

  • Print and complete the form shown below
  • Bring it with you to your appointment
  • Bring your Medicare and Insurance cards to each appointment
  • Bring all your available records and test results (results of your blood tests, X-rays, CT scans, MRI scans, etc), prescriptions and over-the-counter medication that you are currently taking
  • A list of all questions and/or concerns that you may have
  • If you have any questions - please call us on: 1300 551 533

pdfNew Patient Information Form

pdfWeight Loss History Form

pdfPrivacy Information Consent Form

pdfMedical History Form

pdfAssessment Questionnaire Form

You will need the Adobe Reader to view and print these documents.get-adobe-reader

  • Australian Health Practitioner Regulation Agency: AHPRA
  • Australian Medical Association: AMA
  • Royal Australasian College of Surgeons: RACS
  • General Medical Council (UK)
  • Ramsay Health Care - St George Private Hospital
  • St George Hospital, Sydney, Australia
  • Australia & New Zealand Gastro Oesophageal Surgery Association: ANZGOSA
  • St Luke's Care - St Luke's Private Hospital
  • Center of Excellence
  • Award of Bariatric Excellence
  • Master Bariatric Award
  • Inselspital
  • University of Beme
  • Kauno Medicinos Universitetas - Kaunas University of Medicine
  • The Royal College of Surgeons of Edinburgh
  • Obesity Surgery Society of Australia & New Zealand: OSSANZ