630.208.7874

Patient Forms


All new patients will need to fill out the History and Physical forms related to the physician they are seeing and the confidential form. If you are unsure call our office and ask for guidance. Please bring the completed forms to your appointment, along with a list of any medications you take.

Patient H & P Forms

Dr. Kramer – H&P Forms (4 pages)

Dr. Slogoff – H&P Forms (3 pages)

Confidential Form

Additional Forms

Release of Patient Information Form (Required if you would like us to send your medical records to another physician or hospital)

Authorization for Release of Patient Health Information to Self

Colonoscopy Preparation Form (Required bowel prep. for colonoscopies)

Notice of Privacy Practices

 

 

 

Surgery Group S.C.

1665 South St.
Geneva, IL 60134

Phone: 630-208-7874
Fax: 630-208-7880

Business Hours:

Mon., Tues, Thurs.: 9am-5pm

Wed., Fri.: 9am-5pm

© Surgery Group SC All Rights Reserved.