Patient Forms
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Patient Forms
Below are links to our patient forms. These documents are required for all patients. Filling out the forms now will save you time at your office visit and help your surgeon understand your medical history and symptoms.
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Patient Registration Form |
Patient History Questionnaire |
Patient Consent to Disclose |
Authorization to Release Medical Records |
Notice of Privacy Practices |
Miscellaneous Fees |
New Patient Forms Pack
Insurance & Disability Forms
GVS participates with most major insurance carriers in our area (see Insurance Plans), and we are happy to file your service claim free of charge. Our staff members will be glad to review this information with you and answer your questions. Payment is expected when services are provided. Prior to surgery, our Benefits Coordinator will review your policy benefits with you and discuss payment options for surgery.
For your convenience, we accept cash, personal checks, MasterCard , and Visa.
For patients needing to make payments, we have two options available:
Our Easy Pay Plan and Care Credit®, a health care card that allows you to make installment payments for health care services. Please contact our billing office for information.
Disability forms such as FMLA and AFLAC paperwork will incur a $20 fee per form prior to completion. The office can provide a standard form at no cost to the patient. Please allow the staff 72 hours to complete the form. Also, please complete any information that is required by you and make sure your name is on the form.
Common Pre-Op Questions
We understand that patients have many questions when they come to our office. We encourage you to take the time to write down any questions you may want answered. To help you get this started, we have included a few common questions in the link below:
Patient Information
Below are links to informative flyers prepared exclusively for our patients.
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| Carotid Surgery | Colon Cancer | Gallbladder Surgery | Hemorrhoids | Hernia Surgery | Varicose Veins |
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