Patient Registration Forms & Privacy Notices

If you are a new patient, please fill out the registration forms listed below in advance of your appointment to assist the staff in making sure that we have all the information necessary to provide you with quality care and treatment. Please bring the completed forms with you to your appointment.

Registration Forms

Advance Directives

Medication List

Medical History

Patient HIPAA Acknowledgment and Consent Form

Patient Portal User Agreement and Consent

Patient Rights & Responsibilities

Patient Registration Form

Spine Surgery Associates Patient Forms

SSA Spine Patient Registration

SSA Spine Consent to Treat

SSA Spine Patient History

SSA Spine Directions

SSA Spine Privacy Acknowledgement and Disclosure Consent

Diagnostic Center Patient Forms

New Patient Forms

Diagnostic Center Acknowledgment and Consent Form

Patient Rights & Responsibilities

We respect our patients’ dignity and pride. This document will explain your patient rights and responsibilities. It is part of your patient registration and is an important part of your health care plan.

Patient Rights & Responsibilities

Derechos y Responsabilidades del Paciente

Privacy Notices

This privacy notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

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