If not already provided by your surgeon’s office, please print out the necessary forms below in advance of your surgery appointment. This will ensure that we have all the necessary information to provide you with quality care and treatment. Just click on the link below for each form, print, fill it out, and bring it with you on the day of your surgery.
Notice of Non Discrimination (Also available in: Spanish or Hatian Creole)
Authorization and Disclosures (Also available in: Spanish or Hatian Creole)
Authorization to Release Medical Records
Patient Rights and Responsibilities
These forms require Adobe Reader. If you do not have this feature, you may download it free here.
This HIPAA privacy notice describes how health information about you may be used and disclosed, and how you can get access to this information.
Please review carefully.