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New Patient Registration

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  • Thank you for starting your weight loss journey with us!
  • Please complete this registration form, there are 5 pages and it may take about 20 minutes to complete.
  • Once registration is complete, we will call you within 1-2 business days to schedule an initial consult.
  • Please have your insurance cards, all medication/supplement bottles, and the names and phone numbers of all your doctors and specialists close by before you begin this online registration process.
  • Note: Complete this registration in one sitting as you are not able to log in and out this portion of our website. Please call 1-877-269-0355 with any questions- we are happy to help!
  • This site is secure and password-protected and only you and our office have access to your personal data.

I have read the Notice of Privacy Practices for William A. Graber, MD, PC. I understand that I will have the opportunity to ask questions during my initial consult.
* indicates required information
* First Name:
* Last Name
* Phone Number
* Email Address