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Congratulations on taking the final step in this leg of your weight-loss journey. You will now be filling out personal health information. You can choose to print out this form to fill it out and send it via mail or drop it off at the clinic. This form is also interactive and you can fill it out electronically. If you choose to submit via e-mail, please be aware that your information will be sent on a secure site.

As always, confidentially is extremely important to us.

Bariatric Patient History
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 Mercy Medical Center-North Iowa | 1000 4th Street SW Mason City, IA 50401 | 641-428-7000


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