Preparing for a Visit - Surgical Specialists PA

Patient Information Forms


It is very important to complete your forms and forward them to us prior to your visit. You may be receiving paper forms in the mail from our office. ONLY use these forms if you are unable to complete the online forms. Mailing or faxing these forms back to our office so that we will have them prior to your visit is very important.

BEFORE you begin to complete your forms, it may be helpful if you take a moment to be sure you have the following information on hand:

The name and dosage of ALL of your medications

The name and dosing information about all herbal supplements

The dates and descriptions of past surgeries

If you will be completing paper forms at our office, please arrive at least 20 minutes prior to your scheduled office visit. Your information must be entered in your electronic medical record prior to your visit.*

Other Necessary and Helpful Information

If you need to fill out the forms on paper instead of using the online forms, use the forms below.

Click the Patient Information Forms link, fill out and FAX or mail your completed forms to our office prior to your visit. FAX to (316) 945-9131. This will allow us to record your information in the computer prior to your visit.

If it is not possible to complete and mail or fax your forms back to our office prior to your visit, PLEASE complete them, bring them with you and arrive 20 minutes prior to your appointment time. Your information must be entered in your electronic medical record prior to your visit.*

Initial Appointment / Consultation

The Initial Appointment is a Consultation to determine the type of care, procedure or surgery that might be necessary.

Please bring any special insurance forms to your Consultation. If your insurance company requires a referral, you must bring it to your appointment unless your primary care physician has forwarded the referral to our office.

If you could not complete the online Patient Forms and have completed paper forms you received in the mail, if time allows, please mail or FAX (945-9131) them to our office prior to your appointment.

If it has been a year or more since you have seen one of our physicians, please compete a new set of forms on our website, if at all possible, so that we can update your information. Otherwise, please complete the paper forms that have been mailed to you. If you cannot complete the online forms and have not received the forms in the mail, please contact our office.

It is important that you bring the following to each appointment:

  • A current Driver’s License or Photo ID,
  • All current Insurance Cards,
  • Co-payment (Refer to your insurance card, they list the copayment amounts),
  • Referral form (if applicable), and Recent X-ray, Ultrasound, or Mammograms done (if applicable).

*If you are having trouble printing these documents, you may need to download or update your Adobe Reader program. If you are still unable to print the forms, please contact our office and we will mail forms to you. Call (316)945-7309 or (800)945-7308