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  • MMC Weight & Wellness Program
  • 12 Andover Road
  • Portland, ME 04102
  • Phone (207) 661-6064 *NEW
  • Fax (207) 253-6073
  • Website: MMC Weight & Wellness Program

Information to Aid You in Referring Patients

If you are a MaineHealth provider, please enter the referral into EPIC. If not on EPIC, please mail or fax the following information.

  • Referral for the evaluation and treatment of morbid obesity (ICD-9 278.01)
  • Referral authorization # from the insurance company
  • BMI (or most recent height and weight)
  • All related diagnoses and comorbidites
  • Previous attempts/duration of unsuccessful weight loss
  • Demographic Information on the patient (DOB, address, phone number, insurance info)
  • Most recent H&P including blood work and medicationsReferral for the evaluation and treatment of morbid obesity (ICD-9 278.01)

Smokers will be required to quit smoking and have a nicotine level drawn and sent to us before their first appointment. 

First Step for Your Patients

View our online informational sessionAfter watching the video, fill out a health history questionnaire at