Meal Replacement Weight Loss Program Orientation

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Forms to begin the meal replacement program (password required)

At the orientation you will receive the password to access this form to begin the Meal Replacement Weight Loss Program. Once we receive your form, we will contact you within 3-5 business days to schedule your next steps.

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Services described here are provided on a fee-for-service basis. These services are not provided or covered by Kaiser Foundation Health Plan, Inc., and you are financially responsible to pay for them. Clinical services are provided by providers or contractors of The Permanente Medical Group, Inc. Results of services vary among patients and cannot be guaranteed. Kaiser Foundation Health Plan, Inc. ("Health Plan"), and Kaiser Foundation Hospitals may receive compensation for providing facilities and/or other support in connection with these services. These services are not meant to replace any covered services under the Health Plan. If you are a Health Plan member, please check your Evidence of Coverage.

Photo(s) of model(s) shown, not actual patient(s)