Treating the Disease of Obesity ECHO Program


Case Submission Form

Please complete the below form with information that is relevant to your question(s), so that the other ECHO participants can give their best recommendations to you. 

To protect patient privacy, please only include information that cannot be linked back to a patient - including but not limited to - names, locations, dates, employment, or other common identifiers. 
Presenter Information

Key Question(s)

Patient Information

Lab Results:

Medical History

Medications/ Allergies

Additional Information