Patient Forms

At University Endoscopy Center, your time is as valuable to us as it is to you. Upon scheduling your surgery, a member of our staff will provide you with the required forms to fill out. We encourage you to take time to complete these before arriving on day of surgery, so that we may care for you promptly. If you happen to misplace any of the provided forms, duplicates are available for download and print below.

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Anesthesia Consent Form

Download

Multiple Authorization

Download

Notice of Privacy Practices

Download

Patient Registration Form

Download

Patient's Rights

Download

Procedure Consent Form

Download