Patient Forms

Click a link below to download your choice of a patient form.

Patient Pre Surgery Forms

To save time at your appointment, we have provided a printable version of the Anesthesia Pre-op assessment form. Please fill out this form and bring it with you to surgery.

Patient Information

  • Consent and Financial

    This document informs you of the procedure to be preformed and the surgeon performing your procedure and also describes risks of surgery and allows you to consent to treatment. Financial document describes billing procedures and balance responsibility.

  • Statement of Rights and Responsibilities

    This document provides you with your Rights and Responsibilities relating to your surgery. It describes how to file a grievance, provides information concerning physician ownership of our center and sets forth our center’s policy with respect to advance directives.

  • HIPAA Policy

    This Privacy Notice describes how we may use and disclose your protected health information to carry out treatment, payment, or health care operations and for other purposes that are permitted or required by law. It also describes your right to access and control your protected health information. Your “protected health information” means any written or oral information about you, including demographic data that can be used to identify you, created or received by your health care provider, which relates to your past, present, or future physical or mental health or condition.

  • Advanced Directive Notification

    This document provides you with information that all patients have the right to participate in their own health care decisions and to make Advance Directives or to execute Powers of Attorney that authorize others to make decisions on their behalf based on the patient’s expressed wishes when the patient is unable to make decisions or unable to communicate decisions.

To download State specific forms click on the following link: