Appointments & Forms
For Physicians—Making an Appointment
To make an appointment in our Weight Management Clinic:
- The Referring Clinician must complete the Physician Referral Form and fax it along with the insurance referral (Medicaid referrals must be cascading and include the current screening date), growth chart, lab work obtained in the last 6 months, and clinic notes to 205-212-2735. For your patients to receive an appointment, please have the family complete the Parent Form in your office and fax along with the referral. Downloadable Physician Referral (PDF) Please complete this form even if demographic sheet is attached. Patients over age 18 should be referred to UAB's Weight Loss Medicine program. You may contact UAB Weight Loss Medicine at 205-934-7053.
- Once ALL paperwork is received, the patient will be scheduled in the first available slot. Information concerning the appointment will be mailed to the family and the appointment date/time will be faxed to the referring physician. (Please make sure that we have the correct mailing address and contact number for the families)
For Patients
Printable Forms Please use the below forms to help complete the orientation process to our clinic:
Parent Form (must be completed after orientation and received in our office prior to Individual New Patient Appointment)
Parent Form (Spanish)
Stop Light Diet
Stop Light Diet/Spanish
The Road to Healthy Eating
The Road to Healthy Eating/Spanish
Food and Activity Log (Please complete this log and bring with you to ALL Appointments)
Food and Activity Log (Spanish)
Mailing Address
Children's South
Children's SHINE Clinic
1940 Elmer J. Bissell Rd
Birmingham, AL 35243
