Patient Intake Forms | Proliance Puyallup Surgeons

Proliance Puyallup Surgeons Patient Forms

Before you meet with your surgeon, you’ll need to fill out our patient forms. The information you provide helps our clinical care team to most effectively treat your condition.

Whether you require general surgery or urological care, our expert surgeons are here to get you through surgery, into post-surgery care and back to your life as quickly as possible.

Please Fill Out the Requisite Form for Your Treatment Below

General Surgery Forms

Please print and fill out the Patient History Form, as well as any other applicable forms needed. Bring them with you to your appointment.

DOWNLOAD ALL FORMS

Patient History Form

DOWNLOAD FORM

Breast Patient History Form

DOWNLOAD FORM

Patient Information Form

DOWNLOAD FORM

Patients Rights & Responsibilities

DOWNLOAD FORM

Notice of Privacy Practices

DOWNLOAD FORM

Urology Surgery Forms

Please print and fill out the Patient History Form, as well as any other applicable forms needed. Bring them with you to your appointment.

DOWNLOAD ALL FORMS

Patient History Form

DOWNLOAD FORM

AUA

(Prostate Symptom Care)DOWNLOAD FORM

OAB

(Overactive Bladder)DOWNLOAD FORM

Sexual Health Inventory for Men

(SHIM)DOWNLOAD FORM

Patient Rights and Responsibilities

DOWNLOAD FORM

Notice of Privacy Practices

DOWNLOAD FORM

Authorization To Disclose Health Information

DOWNLOAD FORM

Request Medical Records

Here at Proliance Puyallup Surgeons, confidentiality of your medical records is a top priority. We comply with all HIPAA requirements so you can be confident your medical records are safe and secure.

REQUEST RECORDS

PATIENT ADMISSION FORMS (adsbygoogle = window.adsbygoogle || []).push({});

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General Surgery Forms

Patient History Form

Breast Patient History Form

Patient Information Form

Patients Rights & Responsibilities

Notice of Privacy Practices

Urology Surgery Forms

Patient History Form

AUA

OAB

Sexual Health Inventory for Men

Patient Rights and Responsibilities

Notice of Privacy Practices

Authorization To Disclose Health Information

Request Medical Records (adsbygoogle = window.adsbygoogle || []).push({});

PATIENT ADMISSION FORMS

Proliance Puyallup Surgeons Patient Forms

Request Medical Records