Waser Medical Weight Loss Clinic

Call Us:  +1.3212596350

Established Patient Forms


Start Your Path to Better Health

Achieving Better Health Through Weight Loss

What are the Costs of the Program?

After you have scheduled an appointment to begin your journey to better health through weight loss, please print and fill out all of the following forms to take with you to your initial visit.  Contact us at 321-259-6350 if you have any questions.

Portion Size Platter Guidelines (based on a 9-inch plate)


  • Fill 1/4 of your plate with about 3 ounces of protein, such as lean meat, chicken, fish, tofu or beans.
  • Fill 1/4 of your plate with a starch, such as a 1/3 cup of rice, one slice of bread, 1/2 cup cooked potatoes or a small roll.
  • Fill 1/2 your plate with vegetables, such as broccoli, carrots and salad.  Use one tablespoon of salad dressing, if desired.  Choose two or more colors when possible.
  • Add 1 serving of fruit, such as a small pear or apple.
  • Choose 1 cup of skim or low fat milk or 1 cup unsweetened low-fat yogurt. 
  • Add 1 teaspoon of margarine or oil for preparation or addition at the table. 
  • Foods with less that 20 calories per serving are considered "free foods". 

Add other portions as needed to round out your individual meal plan.  For breakfast, use two quarters of the plate and not the other half.  For lunch and dinner, use the whole plate.

New Patient Forms


Healthy Eating means a Healthier You!

Many insurance companies will reimburse for the medical portion of the program, doctor visits, EKG and lab work if you have medical conditions that will be treated by weight loss, for example: hypertension, diabetes mellitus or high cholesterol.  This usually represents half the cost.  You will be responsible for your co-pay and/or cost share.  You will also be responsible for the initial nutritional assessment and weekly meal replacement products.