(All fields required)
Please enter a valid email.
Please enter your name.
The Surgical Weight Loss Program for Teens at Cincinnati Children’s requires a completed copy of our SWLPT referral form signed by the child’s primary care or specialty healthcare provider. It’s important that this referral specifically include the child’s current weight, height and the doctor’s assessment of medical, physical or mental health problems that the overweight condition may have caused. We would also like for the doctor to include the child’s:
Once this information is received by our office, the family will get a questionnaire to complete and return, along with a signed medical record release form and copy of the patient’s insurance card.
To refer patients for bariatric surgery, please complete and submit our referral form.
For more information about the Surgical Weight Loss Program for Teens, use the contact information below
513-636-4453 or 513-636-9215 Toll Free: 800-344-2462, ext. 4453
Pediatric General and Thoracic SurgerySurgical Weight Loss Program for Teens3333 Burnet AvenueMLC 2023Cincinnati, OH 45229
Medical care is provided in the clinics of each department, which are on the Burnet Campus of Cincinnati Children’s.
Use our maps and driving directions to reach the right Cincinnati Children's location.
3333 Burnet Avenue, Cincinnati, Ohio 45229-3026 | 1-513-636-4200 | 1-800-344-2462 | TTY: 1-513-636-4900
New to Cincinnati Children’s or live outside of the Tristate area? 1-877-881-8479
© 1999-2015 Cincinnati Children's Hospital Medical Center