Forms

There are three steps to enroll in the Weigh Smart® Program.

  1. Fill out the New Patient Information form and send to us.
  2. Schedule an evaluation appointment with Weigh Smart® (410-578-5145)
  3. Get labwork through your pediatrician's office.

To return completed forms, you may

  1. Fax them to 410-578-2654.
  2. Email to [email protected].  Please note email is not secure so your child’s health information could be compromised unless encrypted. 
  3. Mail to Weigh Smart program, 1708 West Rogers Ave, Baltimore, MD 21209

Once the forms are received, our program coordinator will call you to set up your child’s evaluation appointment. 

If you have questions:

Molly Schreiber
Program Coordinator
410-578-5145
[email protected]

or

Michelle Demeule
Program Director
410-578-5342
[email protected]

Additional forms:

  1. Financial information
  2. Satisfaction questionnaire.  If your child has completed any of our group programs, please provide us with feedback by completing this satisfaction questionnaire.