We understand your time is valuable, so to save time at your first appointment we ask that you download, print, and return the forms below.
Lincoln Surgical knows your time is valuable; here are some forms to fill out prior to your first appointment with us.
You can mail or bring these forms to our office prior to your meeting with one of our surgeons. Or you may bring the completed forms to your office appointment, but please allow yourself some extra time for that visit. By completing this information prior to your visit, you will shorten your total time for your initial office visit. You will also improve the exchange of information that will help us serve you better.
The following files are in PDF Format. To view a PDF file, download and install Adobe Acrobat reader from Adobe Systems.
Fillable PDF Forms
- Breast History Form – Fillable
- Health History Form – Fillable
- HIPAA Form – Fillable
- Patient Authorization Form – Fillable
- Patient Demographics Form – Fillable
- Risk Assessment for Hereditary Breast and Ovarian Cancer Syndrome Form - Fillable
- Vasectomy Patient Form – Fillable
Instructions: Right-click and “Save Target As” to save a form to your desktop. Open the PDF form. Click anywhere and start typing. Print and fax your form to us at 618.277.7422.
Printable PDF Form
- Breast History Form – Non-Fillable
- Health History Form – Non-Fillable
- HIPAA Form – Non-Fillable
- Patient Authorization Form – Non-Fillable
- Patient Demographics Form – Non-Fillable
- Risk Assessment for Hereditary Breast and Ovarian Cancer Syndrome Form - Non-Fillable
- Vasectomy Patient Form – Non-Fillable
Instructions: Right-click and “Save Target As” to save a form to your desktop. Open the PDF form and print. Fill out the form(s) by hand and fax your form(s) to us at 618.277.7422.
If you have any questions about the forms above or if you would like to schedule an appointment, please contact us.