Weight Loss Center Initial Appointment Questionnaire

Thank you for choosing Guthrie Weight Loss Center. Once you have attended the online or in person seminar, if you wish to make an appointment with our office, the Weight Loss Center Initial Appointment Questionnaire is required to be completed. There are two methods for completing the questionnaire.

Method 1: Complete your Pre-Visit Questionnaire in EGuthrie

To access your questionnaire, log in to your eGuthrie account. If you do not have an eGuthrie account, you may set one up at www.eguthrie.org and click Sign Up Now*.

* Please note that you must have been seen within the Guthrie system to be able to create an eGuthrie account. If you have never been seen at any Guthrie facility, please refer to Method 2 below.

  1. Go to My Medical Record and Questionnaires

    Medical Record Questionnaire

  2. Click on the Guthrie Weight Loss Center Initial Appointment Questionnaire

    Optional Questionnaires

  3. Answer all questions to the best of your ability. Use the 'Continue' button at the bottom of each page to progress through the questionnaire. 
  4. The questionnaire is four pages long. Once you have finished, you will be able to preview and change your answers if necessary. 
  5. Once complete, click 'Submit Questionnaire' to send your completed form to the Guthrie Weight Loss Center.  
  6. Once submitted, someone from the Guthrie Weight Loss Center will review and contact you to make an appointment. 

Method 2: Complete New Patient Information Packet and Submit in Person, by Email Attachment or by Mail.

  1. Download the New Patient Information Packet.
  2. Fill out the patient packet in its entirety.
  3. Upon completion, please save this form to your desktop and submit this information packet either in person, by email attachment to weightloss@guthrie.org or by mail to*:
     
    Guthrie Weight Loss Center
    Guthrie Clinic One Guthrie Square
    Sayre, PA 18840

     

    * We want to safeguard your personal information as best we can. Please do not fax this packet.

  4. Once submitted, someone from the Guthrie Weight Loss Center will review and contact you to make an appointment. 

Thank you, and best of luck as you begin this journey!