When you schedule your initial appointment with one of our
Surgeons or our Nurse Practitioner, you may receive a welcome
packet, including forms, to be completed prior to your visit. We
look forward to making your initial encounter as pleasant and
convenient as possible.
You may download any of the forms from
our website immediately and start to complete them.
Notice of Privacy Practices. Print and complete the
Patient Registration form,
Medical and Surgical history form,
Medication Log & Allergy List. Your appointment card will be mailed from the office.
Once complete all forms should be, signed and dated where required,
and brought with you to your appointment together with your current
insurance cards, driver’s license or other photo ID and a utility
bill if the photo ID does not include your current address.
We participate with most every managed care
insurance plan. Should your particular plan require referral when
you visit our specialists, you must contact your primary care
physician, let that physician know when you will be coming to our
office, and request a referral. Some referrals are transmitted to us
by your physician electronically. Some may be mailed and some may
require you to pick up the paper referral and bring it with you to
your appointment. In the absence of your referral, we will be happy
to provide care; however, your insurance may not be responsible for
our charges, and you will be required to sign a waiver assuming
responsibility for payment.
Forms to fill out prior to your initial your office visit
these at home, fill them out and bring them with you for your first
- Notice of privacy practices (HIPAA)
Designation for release of medical information
Medical and surgical history form
Medications and allergies
If you leave filing out the forms until you come to see us, you may significantly delay your appointment and to avoid delaying other patients too, rescheduling your appointment may be necessary. If this is your first visit for weight loss surgery, the weight loss surgery inital patient assessment form must be completed prior to your visit.
You will be contacted in advance of your visit to confirm the date, place and time of the appointment. We request you bring with you a list of your current medications including the name, strength, dosage and how often you take each prescription.
When you are completing the medical history forms, please pay special attention to the history form as well as the medication log and allergy list that includes a section about allergy to medications. This essential information will become a part of your record here.
If you have had recent tests associated with the current problem for which we are seeing you, please arrange with the office staff to obtain copies of your written test results. They may, at the time you discuss those test results, ask you to bring films of studies performed. The staff will be happy to work with you to facilitate that process.
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