Forms for Our Patients
To Schedule:
- Request a surgical packet or download forms from the internet.
- Complete forms #1 and #2 (below) and return via fax, mail or email.
- Dr. Gatewood will review and determine if any pre-testing and/or
additional information may be needed.
- Once all pre-testing and/or additional information is obtained a
surgical date can be reserved.
- Selection of the date and deposit will be paid at the same time. We
accept Visa, MC, and Discover.
Below are the MS Word documents that you can print and send to us (by
U.S. mail or fax):
| Mailing address: |
John S. Gatewood, MD
316 53rd Ave. E.
Bradenton, Florida 34203 |
| Fax: |
941-739-8528 |
Should you have any questions,
please contact us.
- Patient Registration Form
(PDF file)
- Pre-Surgical / Anesthesia Questionnaire
(PDF file)
- Consent for Surgery (PDF
file)
- Consent for I.V.
Sedation (PDF file)
- Medical Clearance Form (only if required
by Dr. Gatewood)
- Authorization to Release Health Care Information
(PDF file)
- Deposit Agreement (PDF
file)
|
