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Patient
Registration Forms
Please take the time to fully and completely fill out
these forms. Write your legal name and date of birth at
the top of EACH page, and sign where directed. This
information is very important to your healthcare. Please
use BLACK INK
History and
Physical Form
History
and Physical Form for Bariatric Patients
Patient
Information Form
Patient Bill of
Rights
Thank
you for choosing NEW Surgical Associates for your
healthcare needs. We look forward to meeting you. Please
arrive 30 minutes before your scheduled time for your
first appointment. To make your visit to our office more
efficient, the patient registration forms necessary for
your initial appointment are available for you to print.
Please fill them out and bring them with you on the day
of your visit.
* In
addition, please remember to bring the following:
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Your insurance card(s).
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Co-payment(s) required by your insurance plan. For
your convenience, we accept cash, checks, Mastercard,
and Visa.
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The
name of the hospital of choice under your insurance
plan.
If your
insurance plan requires a referral, please make
arrangements with your primary
care provider prior to your appointment. If a referral
has not been received by the date of
your appointment, the appointment may need to be
rescheduled.
If you have any questions,
please feel free to call us at (920) 494-9685 or
toll-free (800) 453-2682.
The Staff of NEW Surgical
Associates
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