Request an Appointment

Tell us about yourself

Please use this form only if you are a new patient. Existing patients please call to make an appointment 717-898-2356. If you have an emergency, Call 911.

TELL US ABOUT YOURSELF

CHOOSE A LOCATION

CHOOSE A PROVIDER

CHOOSE DATE & TIME

Are you a new patient?

Yes

No

Please select an option.

Has your insurance changed?

Yes

No

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Patient First Name

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Patient Last Name

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Email

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Phone Number

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I would like to receive text communications from Medical Weight Loss Center of Lancaster, such as appointment confirmations, appointment reminders, and feedback requests. Message & Data rates may apply.

Insurance

Please enter insurance.

Date of Birth

Please enter your date of birth (mm/dd/yyyy).

Reason for Request

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We will be happy to bill your insurance. Although most insurances cover weight management, it is suggested you verify your individual coverage with your insurance company. We also accept self pay patients. For these patients, all services must be paid at time of appointment. Unfortunately, we are not accepting any new patients with state insurance.

Please use this form only if you are a new patient. Existing patients please call to make an appointment 717-898-2356. If you have an emergency, Call 911.