Current Patient Forms

Below please find forms available to our current patients. Please use these forms based on your prescribed extreme weight loss protocol.

These forms should be downloaded, completed and faxed to your Last Diet Ever location or brought to your next appointment. Please note that if you email these forms to your counselor, email transmission is not considered secure and should only be used to transmit non-confidential information.

Food Journal - hCG Patients

Financial Policy

Care Credit Financing


Fax numbers:

Avon - 440-934-3428

Mansfield - 419-529-5677

Medina - 330-721-1456

Sandusky - 419-502-0203

Westerville - 614-392-2849