Meet Our Doctors Why Choose Us How Our Program Works Beyond Weight Loss Testimonials

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(704) 271-9757 Free Consultation

About Meet Our Doctors Why Choose Us How Our Program Works Beyond Weight Loss Testimonials

Shop Fullscript Contact Patient Forms (704) 271-9757 Free Consultation

Patient Intake

Patient Forms

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Patient Intake

Welcome.

Please complete the forms below before your first appointment. If you have any trouble, call us at (704) 271-9757.

New Patient Intake Form

PDF · Complete before first visit

Health History Questionnaire

PDF · Detailed medical and lifestyle history

HIPAA & Privacy Authorization

PDF · Privacy practices and acknowledgement

Forms are placeholders during the website rebuild. Final PDFs will be linked here before launch.

Physician-supervised, functional-medicine weight loss. Dr. Lidia Adkins and our network of providers help patients reach a sustainable, healthy weight through anti-inflammatory nutrition and personalized metabolic protocols.

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Meet Our Doctors
Why Choose Us
How Our Program Works
Beyond Weight Loss
Patient Stories
Blog
Contact

Get In Touch

216 South New Hope

Gastonia, NC 28054
(704) 271-9757
24-hour appointment line
infog@cwli.net

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© 2026 Carolinas Weight Loss Institute.

Results vary; side effects may include headaches and increased hunger during the first week of treatment. Examples represent individual results and may not be typical.