Surgery Patient Info

To our surgery patients:

Correct Patient Information

It is very important that you make sure we have your current address and phone numbers so that our office and the facility can reach you.  Cell phone numbers are always helpful.  At times there will be changes in the surgery schedule and/or it might be necessary to contact you regarding your lab work or medications before surgery. Your cooperation in this matter is greatly appreciated and will help to eliminate any problems that may result in not being able to reach you. Failure to respond to phone calls regarding your procedure may result in your procedure being cancelled.

Consent Forms

It is mandatory that we have your completed and signed consent forms returned to our office at least 3-5 days prior to your surgery.  Failure to return your forms may result in your surgery being cancelled and/or rescheduled. If your procedure is scheduled close to the date of service, we may need to either communicate them through fax, or you may need to come into the office to sign them.

FMLA/Disability Papers

Please bring your paperwork in at least 2 weeks before your surgery in order to give your doctor time to fill them out and get them back to you before your surgery date. There will be a $25.00 fee for this service.

Reminder Calls

You are to go by the information given to you by the scheduler. If there are any changes regarding your surgery, either our surgical coordinator or the surgical facility will contact you. If you wish to cancel your procedure, please contact the surgical coordinator.

These instructions have been reviewed with me by the surgical coordinator and I understand the above information. I also acknowledge that I have received all information pertaining to my surgery and have received a copy of all signed documents.


X_______________________________________                           X_______________    
Authorized Signature (Patient or Legal Guardian)                        Date          

 

Please print this page, sign and date it and bring it with you to your next appointment

Creekwood
5330 North Oak Trfwy.
Suite 201
Kansas City MO 64118
P 816-454-0666
F 816-454-1694

Liberty-Seaport Complex
124 Westwoods Drive
Liberty MO 64068
P 816-883-2965
F 816-454-1694

Georgetown
8901 W. 74th Street
Suite 145
Merriam KS 66204
P 913-722-0020
F 913-362-0583

College Boulevard
8490 College Boulevard
Overland Park KS 66210
P 913-722-5551
F 913-362-0583

Scheduling
816-454-2655

Skin Renewal Scheduling
(Creekwood and College)
913-831-4880