Psychiatric Provider Letter of Support - A guide for your provider

Sep 16, 2026

Guidance for requesting a formal psychological evaluation and clearance for patients entering a bariatric surgery program. For patients with an established relationship, the provider must state no psychological contraindications for surgery. For others, a psychologist or psychiatrist must assess readiness to follow directions and long-term follow-up, including any major axis disorders or bulimia, addiction risks, behavioral modification capacity, coping mechanisms, and suicide risk. The letter also instructs how to address recommendations if surgery is not ready, and provides submission contact details.

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CategoryLetters

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Pages2

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Psychiatric Provider Letter of Support

Purpose and when an evaluation is required

Evaluation criteria and questions

Program support and submission instructions

Psychiatric Provider Letter of Support A guide for your provider If you have an established relationship with a Psychologist or Psychiatrist, please obtain your psychological evaluation from your provider. It must indicate that there are no psychological contraindications for surgery. For patients that do not have an established relationship with a psychiatric provider, you must see a psychologist/ psychiatrist to obtain a formal psychological evaluation and clearance. You are being referred as a part of the preoperative screening and planning process necessary for all patients entering the bariatric surgery program. By way of this evaluation, we are requesting an assessment in a written format to determine your ability to understand directions and your willingness to adhere to long term follow up care. In addition, knowledge of any major axis disorders or bulimia is necessary. To assess these requirements, standardized psychological testing may be needed. To assist the psychiatric provider, the following points should be addressed: • Does the patient appear to understand the commitment he/she is making by undergoing weight reduction surgery? • Does the patient appear to have any disabilities that would prevent understanding and following directions? • Does the patient currently have an addictive disorder such as alcoholism or drug abuse? • Does the patient have a major axis disorder? If so, what? • Does the patient appear to have the ability to undergo major behavior modification? • Does the patient appear willing to forgo foods as a main comfort source? • Are mechanisms present to foster development of suitable coping mechanisms? • Is the patient suicidal? • Does the patient appear to be sincere in his/her ability to take part in a long-term followup and group support meetings? • In your opinion, is the patient willing to comply with long-term lifestyle changes? • In your opinion, is there any reason why this patient should not undergo procedure to limit his/her capacity for food and forced food aversion? If you feel the patient is not ready to proceed with surgery, please list your recommendations instructed to the patient and forward to us in writing. We have a comprehensive program including support groups and available dietitians to help patients in meeting their weight loss goals. Please mail or fax your psychological evaluation to Tulane Surgery Clinic HC20, 1415 Tulane Ave, N.O., LA 70112 or secured fax: 504-988-1936 ATTN: Bariatric Nurse (fax preferred) . If you have any questions or concerns please contact our office for assistance at 504-988-5110.

FAQs

What must the psychological evaluation confirm for surgery eligibility?

The provider must indicate there are no psychological contraindications for surgery and assess the patient’s ability to understand directions and adhere to long-term follow-up care.

Who should obtain the evaluation if there is no established psychiatric provider relationship?

The patient must see a psychologist or psychiatrist to obtain a formal psychological evaluation and clearance as part of preoperative screening.

Which specific clinical topics should the provider address to support bariatric surgery planning?

The provider should assess commitment to weight reduction surgery, ability to follow directions, addictive disorders, major axis disorders (and specify if present), bulimia, behavioral change ability, coping mechanisms, suicide risk, sincerity toward long-term support, and willingness to comply with lifestyle changes.

Sep 16, 2026

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