Resources

Patient Forms

Absence Request (PDF)

Acknowledgment and Consent (PDF)

Appointment Confirmation (PDF)

Authorization to Disclose Information (PDF)

Disclosure of Medical Records (PDF)

Elective Self Pay (PDF)

General Surgery Assessment (PDF)

Patient Intake Form (PDF)

Patient Informed Consent (PDF)

Patient-Informed Consent - RFA (PDF)

Patient-Informed Consent - Foam Sclerotherapy PDF)

Work Release Form (PDF)

Patient Forms - En Español

Acknowledgment and Consent (PDF) - en Español

Appointment Confirmation (PDF) - en Español

General Surgery Assessment (PDF) - en Español

Patient Intake Form (PDF) - en Español

Pre-Op and Post-Op instructions

Bowel Prep Instructions (PDF)

Breast Health Assessment (PDF)

Post-Op Instructions - RFA (PDF)

Venaseal Aftercare Instructions (PDF)

Referring Offices

Information for Referring Office (PDF)

Additional Information Resources

Good Faith Estimates (PDF)

Trusted Physician Association Member

We are a proud member of the AllCare Independent Physician Association. Along with more than 70 independent physicians in Josephine and Jackson counties, we’re working together to provide quality, cost-effective healthcare for our communities.