Patient Information

Patient Forms

New Patient Registration Form

Print this form and fill it out to save you some time in the office! You will need your insurance information, contact information, phone numbers, etc.

Patient Intake Revision 10-2008.pdf

Medical Records Authorization

This is a release form that allows use to access and utilize your medical history -- it basically ensures we have access to your pertinent medical information.

med-records-authorization.pdf

Health Summary

Print this form and fill it out to save you some time in the office! You will need to provide some past medical history,a list of your medications (with doses), and your family medical history.

HEALTH SUMMARY rev dec 08.pdf

Consent of Disclosure

Print this out, read it, and bring it with you for your appointment. This is a release form that allows use to access and utilize your medical history -- it basically ensures we have access to your pertinent medical information, and that we can pass that information on to other providers (physicians, hospitals, etc.) to ensure you receive appropriate care.

consent-of-disclosure.pdf
Information

Preoperative Bowel Prep Instructions

Patients undergoing colon surgery will require a bowel preparation to cleanse the colon in order to decrease the risk for infectious complications. If you are unsure of what your instructions were, or you have lost them, this is a copy of our standard preoperative bowel prep instructions.

CSSA Bowel Prep.pdf

Inguinal Hernia Repair

Diagnosed with an inguinal hernia and unsure of what will be involved with its repair? This is a description of the signs and symptoms of inguinal hernias, as well as a description of the surgical management of this common problem

inguinal-hernia.pdf

Laparoscopic Gallbladder Removal

Gallbladder disease is very common and frequently requires surgical treatment. These informational sheets describe the symptoms, diagnosis, and treatment for gallbladder issues.

lap-chole-instructions.pdf

Laparoscopic and Conventional Colon Surgery

Colectomy, or removal of a portion of the colon, is a fairly common procedure. As with many other operations, a minimally invasive (laparoscopic) approach is feasible for many patients. This information sheet provides a description of what to anticipate with both laparoscopic and conventional open surgeries, whether for benign or malignant disease.

CSSA Colectomy.pdf

Preoperative Diet for Bariatric Surgery

Patients scheduled for bariatric surgery, whether laparoscopic gastric bypass surgery or LAP-BAND surgery, are requested to follow this diet for 10 days prior to surgery. This allows your body to use some of the fat stored in the liver just before surgery, thereby decreasing its size and allowing better visualization in the upper abdomen.

Preoperative Bariatric Diet.pdf

Gastric Bypass Diet Regimen

Patients undergoing Roux en Y Gastric Bypass surgery have a strict dietary regimen to follow. This PDF file outlines the diet as it progresses from the first few weeks following surgery through the first 12 months.

GBP Diet.pdf