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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

Payment & Insurances

At Far North Surgery, we offer multiple payment options to our patients. We accept the following payment types:

  • Visa Visa
  • MasterCard Master Card
  • American ExpressAmerican Express
  • Debit Cards Debit Cards

We do insurance verification, pre-authorization, FMLA paperwork for surgical patients, medical necessity letters for authorizations and appeals. We accept various payment plans; however, this needs to be discussed on a case by case basis. Contact the office to discuss payment plan options.


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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