Patient Forms
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
Instructions: Right-click and “Save Target As” to save a form to your desktop. Open the PDF form. Click anywhere and start typing. Once complete, print and bring your forms to our office or fax your form to us at 618.277.7422. Forms cannot be submitted online or electronically.
- 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
Printable PDF Form
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. Once complete, print and bring your forms to our office or fax your form to us at 618.277.7422. Forms cannot be submitted online or electronically.
- 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
If you have any questions about the forms above or if you would like to schedule an appointment, please contact us.
Privacy Practices
The practice provides its Notice of Privacy Practices to every patient with whom it has a direct treatment relationship. To read the full privacy policy, please download and read the PDF.