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Nutrition Appointment Request Form

To request nutrition counseling, please complete the secure online form below or call us at 1-800-CK-HEALTH (1-800-254-3258). A representative will get back to you the next business day.
Please be advised that in order to participate in nutrition counseling you must have attended Dr. Katz's seminar and had an appointment with Dr. Katz. Please go to "Surgical Weight Loss" under the classes and events link to see available seminars.
Please fill out the following fields as completely as possible.
* Denotes required fields

Patient Information

* Have you attended Dr. Katz's Weight Loss /Bariatric Surgery educational seminar?
The Outpatient Nutrition Center is unable to provide counseling to patients under the age of 16. The Bariatric Center is unable to provide counseling to patients under the age of 18.

Insurance Information

* Do you have insurance?

Reason for Appointment Request

Locations

Nutrition Outpatient Center

Crozer-Chester Medical Center
One Medical Center Blvd.
Upland, PA 19013
610-447-2300

Bariatric Nutrition Location

Crozer-Chester Medical Center

One Medical Center Blvd.
POB II, Suite 326
Upland, PA 19013
610-619-8450

Contact Us

Nutrition Counseling
1-800-CK-HEALTH
(1-800-254-3258)

Bariatric Nutrition Counseling
1-800-CK-HEALTH
(1-800-254-3258)