New Patients
Patients who are new to Chestnut Hill Surgical Associates at Chestnut Hill Hospital will have to complete some paperwork prior to their first visit. Rather than having to sit in the waiting room and do the paperwork, we have posted the forms here on our website so that you can download them and complete them in the comfort of your own home.
Each surgeon has a package of forms that we require new patients to read and complete prior to your first visit. You will need to have Adobe Reader on your computer to access these documents. If you need Adobe Reader, you may download a free copy by clicking on the icon at the bottom of this page.
The first form is Chestnut Hill Surgical Associates at Chestnut Hill Hospital's Notice of Privacy Practices required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
The second form is our Privacy Practices Acknowledgement Document that you are required to sign indicating that you have read and understood the first document, our Notice of Privacy Practices.
The third form in each package is a Patient Survey Document that is unique to each surgeon because each type of surgery will require them to know different types of information about you. Dr. Bailey's forms package has an additional form.
The last form is our standard New Patient Information Sheet for your file.
Here are the forms packages for each surgeon:
- Dr. Barbot's forms package
- Dr. Bailey's forms package
- Dr. Butcher's forms package
- Dr. Cowan's forms package
- Dr. Kahn's forms package
- Dr. McCombs' forms package
- Dr. Tohamy's forms package
