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:

  • General medical history
  • Prior treatments
  • Results of testing and weight loss attempts, including dieting records, that may be relevant to the overweight condition

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.

Contact Us

For more information about the Surgical Weight Loss Program for Teens,  use the contact information below


Toll Free: 800-344-2462, ext. 4453




Mailing Address

Pediatric General and Thoracic Surgery
Surgical Weight Loss Program for Teens
3333 Burnet Avenue
MLC 2023
Cincinnati, OH 45229


Medical care is provided in the clinics of each department, which are on the Burnet Campus of Cincinnati Children’s.