Initial Application for Obesity Surgery Consideration
Completing and submitting this application is considered a request for coverage. You may apply only once per calendar year.
You can fill out this application online OR download the form 
( 13K), print it, and mail it to:
Uniform Medical Plan
Obesity Surgery Request
P.O. Box 34578
Seattle, WA 98124-1850
Please do not send any other paperwork or records at this time.
