ONLINE FORMS


NEW PATIENT FORMS

Please complete the following forms and mail them to our office or bring them with you to your appointment. 


WEIGHT LOSS PATIENT FORMS

Weight loss patients must complete an online Patient Information Form after attending a seminar.  The form must be completed at least 1 week prior to your consultation with the doctor.  Please contact our office if you need help accessing or completing your Patient Information Form.


MEDICAL  RECORD RELEASE AUTHORIZATION FORMS

If you'd like a copy of your medical records sent to another facility, please complete and return a signed authorization form to our office:

Attention:  Medical Records
Surgical Institute of South Dakota
911 E. 20th St. #700
Sioux Falls, SD 57105
 
(605) 334-6028 Fax


Use this form to authorize your physician to release your medical records to Surgical Institute.

Use this form to authorize Surgical Institute to release your medical records to another physician, or for any other purpose.