Patient Pre-Registration

Patient Pre-Registration

Thank you for choosing Far North Surgery.

Please download and print the forms on this page. You may fill them out at home, or at our office on the day of your procedure. This will help us start the pre-surgical assessment process and document your medical history before starting your surgery.

Be sure you have the following information to complete the registration process:

  • Emergency contact information
  • Your healthcare insurance information
  • Your past medical/surgical information
  • Your pharmacy information
  • Referring physician, and primary care physician information
  • Your family medical history
  • Current problems/medications
  • Social history
Patient Registration

Patient Registration
Form

Download
Patient HIPAA Acknowledgement and Consent Form

Patient HIPAA Acknowledgement
and Consent Form

Download
Patient Consent for Financial Communications Form

Patient Consent for Financial
Communications Form

Download
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