Enrollment Information


Approval from your physician and an initial assessment is required before you can participate in the SHAPEDOWN program.

Patient and Family Instructions on how to get started with the SHAPEDOWN Program:

  1. Download and print the Shape Down Program Registration Form and Physician referral letter.
  2. Bring the referral letter to your doctor. After his/her review, have the physician referral faxed to the SHAPEDOWN Program at 319-384-7901. We must receive the physician referral prior to scheduling an intake meeting.
  3. Contact your insurance provider regarding which components are covered by your insurance. Feel free to discuss with Krista, SHAPEDOWN Program Intake Coordinator.
  4. Schedule an appointment with the SHAPEDOWN Program's counselors, by phoning 319-384-7900. Download registration forms. Completed registration forms will be reviewed as your adolescent's initial appointment.
  5. Bring the physician referral letter to your adolescent's initial visit along with completed registration forms and insurance information.
  6. Soon after the intake, your adolescent will be scheduled for a fitness assessment

Forms



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Last modification date: Thu Jun 26 10:57:14 2008
URL: http://www.uihealthcare.com /depts/med/pediatrics/weightmanagement/enrollment.html