Patient Forms

Patient Forms

In this section you will find some general instructions with regards to your procedure and FORMs to be completed it before arriving at the Center. Please inquire about receiving this form in a brochure distributed from your doctor, if preferred.

• TO OUR VALUED PATIENT / ENROLLMENT FORM (English) (PDF)
• TO OUR VALUED PATIENT / ENROLLMENT FORM (Spanish) (PDF)

In this section you will find all Medical Consents that you should expect to sign on the day of your procedure. These consents are downloadable PDF versions and are available for patients to read so that they may familiarize themselves with the procedure and prepare questions to their provider.

• PROCEDURE CONSENT (ENGLISH) (PDF)
• PROCEDURE CONSENT (SPANISH) (PDF)
• ANESTHESIA CONSENT (ENGLISH) (PDF)
• ANESTHESIA CONSENT (SPANISH) (PDF)

In this section you will find: “Patients’ Rights and Responsibilities; Notice of Privacy Practices; Information on Advance Directives; Patient Acknowledgement of Financial Responsibility; Physician Ownership Disclosure; Notice of Nondiscrimination”. Patient’s Consent to the below DISCLOSURES, NOTICES and ACKNOWLEGEMENTS is required in order to guarantee treatment.

• PATIENT’S DISCLOSURE / NOTICES / CONSENTS (English) (PDF)
• PATIENT’S DISCLOSURE / NOTICES / CONSENTS (Spanish) (PDF)

Other forms:

In this section, you will find other information and instructions related to our facility and your procedure.

• GSE PATIENT INSTRUCTION BROCHURE (ENGLISH) (PDF)
• GSE PATIENT INSTRUCTION BROCHURE (SPANISH) (PDF)
• GSE PATIENT INFORMATION BROCHURE (ENGLISH) (PDF)
• GSE PATIENT INFORMATION BROCHURE (SPANISH) (PDF)