Patient Forms

Patient Forms

In this section are downloadable PDF versions. These consent forms are available for patients to read so that they may familiarize themselves with the procedure.

• Patient Consent for Procedure (English, PDF)
• Patient Consent for Procedure (Spanish, PDF)
• Patient Consent for Anesthesia form (English, PDF)
• Patient Consent for Anesthesia form (Spanish, PDF)

Included in this section are patient privacy forms, acknowledgement of patient responsibilities, and consent to be contacted explicitly to schedule and secure treatment options, dates and times. Consent is required in order to guarantee treatment.

• Privacy Practices (English, PDF)
• HIPAA Statement Consent Form (English, PDF)
• HIPAA Statement Consent Form (Spanish, PDF)
• Patients Rights and Responsibilities with Advance Directive Information (English, PDF)
• Patients Rights and Responsibilities with Advance Directive Information (Spanish, PDF)

Patients are required to download this form and complete it before arriving at the Center. Please inquire about receiving this form in a brochure distributed from your doctor, if preferred.

• Patient Enrollment form (English, PDF)

Other forms:

• Financial Responsibility form (English, PDF)

Information Brochure:

• GSE Patient Instruction Brochure (English, PDF)
• GSE Patient Instruction Brochure (Spanish, PDF)
• GSE Patient Information Brochure (English, PDF)
• GSE Patient Information Brochure (Spanish, PDF)