Weight Management Patient Application for Southern Illinois

Get Started Today!

Complete the form to begin your weight loss journey.

Please enter as MM/DD/YYYY

Please enter a five-digit ZIP code

Please enter phone number as XXX-XXX-XXXX

Please indicate height in feet and inches

Please indicate weight in pounds












Please select your top choice



Please enter phone number as XXX-XXX-XXXX

Please enter as MM/DD/YYYY

Please enter phone number as XXX-XXX-XXXX

Please enter as MM/DD/YYYY







Woman on a run


Start Your Weight Loss Journey

At SSM Health Weight Management Services, our weight-loss program helps people live improved, healthier, and longer lives. We offer many surgical and non-surgical options. Our board-certified physicians specialize in minimally invasive weight-loss surgery. Get started on the weight loss solution that is best for you.


SSM Health Weight Management Services patient application is available for Southern Illinois. Once we receive your completed form, we will start the verification process with your insurance company.


Looking for a different location?

Are you searching for an application in another location? We offer weight management services in other service areas, too! Find the right application for your area: