Patient Resources

New Patient Resources

For easier scheduling, New Patients should print one of each of the following forms. Please fill them out prior to your appointment and bring them with you. Be sure to bring all your insurance cards to appointments as well. (Patients without insurance cards, paper referral if needed, and copayments will not be seen)

• New Patient - General Information Form
• New Patient - Existing Conditions Form
• New Patient - Insurance Information Form
• New Patient - Release Authorization Form
• New Patient - Current Medications Form
• New Patient - Privacy Policy Form

Patient Questionnaire

At Laurel Ridge Surgical Associates we are constantly striving to improve the quality of patient care. Your input is very important to us. Please take a moment to answer a few questions about your experience at our practice. You can fax the completed form to:
724-434-5485
or mail it to:
196 West Main Street
Uniontown PA, 15401
or drop it off to our front desk staff anytime.

• Patient Questionnaire Form

Miscellaneous Resources

• Diet after a Nissen Fundoplication
• Direct Schedule Scope Fax Request

• © 2010 Laurel Ridge Surgical Associates
• Site design by FullPulp