ADVANCED LAPAROSCOPIC, BARIATRIC, ENDOSCOPIC & GENERAL SURGERY

Improve Your Health and Lifestyle Through Weight Loss for Life

Great Lakes Surgical Associates are proud
members of the Bariatric Surgery Center of Excellence

Click to visit surgicalreview.org

Patient Forms

The following patient forms are mailed out before your first appointment and are also available for you to download for your convenience. Each must be filled out before your first appointment OR if you have not been seen by our doctors within a year.

You may need to download Adobe Acrobat to view these files. Click here to download the reader from Adobe.com

  • New Patient Information: This form collects all basic necessary information on our patients that we must keep on file.
    Download New Patient Information PDF

  • Consent to Share Medical Information: This must be filled out in order for us to share their results or medical information with a family member or friend.
    Download Consent To Share Medical Information PDF

  • Notice of Privacy Practices: This form describes how medical information about you may be used and disclosed, and how you can obtain access to this information. The privacy of your medical information is very important to us.
    Download Notice of Privacy Practices PDF

  • Patient History: This form collects medical history information of our patients, in order for our healthcare providers to best understand our patient's medical concerns and needs.
    Download Patient History Form