Application For Inclusion on Obesity Physician Locator
My Weight - What To Know is a resource for people living with obesity in Canada. As part of our work to encourage people to seek medical attention for weight management, our website provides a searchable physician locator tool that allows individuals to find relevant resources near them.

If you'd like to be considered for inclusion in this locator, please fill out the form below. Please note-- you can fill in your information without having to edit this form. If you have any questions, feel free to send an email to us at vanessa@myweightwhattoknow.com Many thanks!
Sign in to Google to save your progress. Learn more
Physician Name *
Are you a licensed physician? *
Clinic / Practice Name *
Describe your clinic/practice to any prospective patients, and add anything you might like them to know before contacting your clinic (please limit to 1-3 sentences)

Here are some generic example descriptions from current listings:

Weight Care Clinic - We are an obesity management clinic offering a multidisciplinary approach to medical management of obesity. Support is provided to individuals with obesity who require complex medical management and/or surgical intervention.

Healthy Weight Management - Medically supervised weight loss - Virtual program now accepting new patients. Open to residents of the province with a Physician referral.

Lakeview Health Clinic - we offer a comprehensive and individually customized 12 month medical weight management program that treats weight loss for what it is; a Chronic Medical Condition. We support patients with personalized programming based on their unique biology, values and goals.
Clinic / Practice Website
Office Address *
Office Address cont. (Suite or Number - optional)
Office City *
Office Postal Code *
Office Province *
Office Phone Number *
Do you offer telemedicine appointments? *
Email address (this will NOT go on the locator-- it is for us to confirm your willingness to be included in the future. Please note that we MUST be able to contact you at this address once a year to verify your clinic info.) By submitting this form, you acknowledge you will need to respond to a yearly verification email or your listing will be removed.
 *
Certifications (Check all that apply) *
Required
Do any of your programs have out of pocket costs?
 *
By submitting this form, you are agreeing to be listed on our locator. Thank you!!              
Thank you for participating!
My Weight - What To Know reserves the right to include physicians that we find align with our certification requirements and overall platform objectives.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of What To Know, LLC.

Does this form look suspicious? Report

Google Forms